NP's are okay to see if you have a cold, BUT...

Specialties NP

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I want to become a nurse practitioner. At least, I'm pretty sure I do. I can't say with 100% certainty but it is definitely something I am interested in. I think I would like having my own clinic where I am the one who tells who to do what and when (though I'm not a control freak by any means).

Anyway, I just wonder what the scope of practice is for NP's in a nutshell. I know I can check the state board of nursing but without getting lost in a long spiel a long spiel can anyone sum it up for me here?

I assume, even though an NP can be a PCP, that an NP mostly treats colds, minor infections, gives physicals to truckers...but a NP certainly is not a doctor (even though the name on prescription bottles usually reads "Dr. so and so".)

Anyway, thanks for any advice. And don't anybody bite my head off because I want the Reader's Digest version instead of a book.

The truth is, most medical professionals begin to feel that they can do most - if not all - of the jobs of those more academically trained. The other ER techs feel that we should be able to start IV's (with our CNA and EMT - B licenses).

Crazy,

Keep in mind that if your CNA's and EMT-B's are licensed, that makes your state a rarity. Given that, it makes sense that the practices of nursing and advanced practice nursing may also be significantly different in your area, making for poor comparisons. Here in Texas, we've started licensing some degreed paramedics in the last few years, but the CNA and EMT-B still just hold certifications.

Regarding ordering labs/X-ray/EKG on an anxiety patient, surely you know that we order medical diagnostics and interventions in this country based on what could be wrong with a patient and not based on what we actually think is wrong. It's not generally an issue of assessment gone awry, but one of liability.

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Specializes in Telemetry, ICU, Psych.
Crazy,

Regarding ordering labs/X-ray/EKG on an anxiety patient, surely you know that we order medical diagnostics and interventions in this country based on what could be wrong with a patient and not based on what we actually think is wrong. It's not generally an issue of assessment gone awry, but one of liability.

So true. Especially in the case of emergency medicine.

The point of my earlier reply is to respond to a poster's idea that the training of NP's in general practice equals that of MD's, due to pt's preference to see an NP instead of a medical doctor.

CrazyPremed

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Specializes in ICU, ER, HH, NICU, now FNP.
So true. Especially in the case of emergency medicine.

The point of my earlier reply is to respond to a poster's idea that the training of NP's in general practice equals that of MD's, due to pt's preference to see an NP instead of a medical doctor.

CrazyPremed

I don't see where that was even implied!

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When I'm diagnosing and prescribing in my practice, what am I doing? I know what the correct answer is, but it kind of feels like the other answer. Although, I do have a nurse that does all the nursing duties. And of course some NPs are as good or better than some MDs and vice versa in primary care. I can cite case after case where that is true. I can choose to work with an MD or I can choose to work independently without them. I don't work under them...well I did once, but that was just for fun. ;) :) I have a good working relationship with all the docs I associate with. I respect them and they respect me. I collaborate with a great MD currently. I consult with him on occassion, and he consults with me on occassion. I take care of 80-90% of my patients needs and for the other 10% of their problems they count on me to know which competent MD specialist to refer them to, and more likely than not they won't get to see the MD specialist, but they will be fortunate enough to see their NP or PA.

I don't make decisions about my healthcare based on someone's credentials. I make it based on their reputation. I suggest you do the same, or you might find yourself all jacked up blubbering in the corner muttering "I don't understand it, he had the initials MD after his name". I think for some here the term MD means Magical Degree.

Certain posters here don't understand jack about what I'm talking about. And no, a certain poster here doesn't know the answer to his/her own question. Just more posturing and defensiveness because not everyone will blindly regard him/her as a pillar of knowledge and authority because he/she has a master's degree and works in a clinic.

I hate what this has turned into, because I don't disrespect nurse practitioners or belittle what they do. But obviously, as with any profession or group of people, there are egos out there that will not respond to any amount of reason. Give some people a little authority and it makes their heads swell up so big they need to be tied down to keep from floating away.

(And speak for yourself about the blubbering.)

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Specializes in ICU, ER, HH, NICU, now FNP.

It is true that there are egos in every profession - I can say that I have worked with as many or more prima don/donna nurses, power hungry managers and geek tripping programmers as balloon head MD's.

But then...Im not so sure that's as much ego as it is delusion :) LOL

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Specializes in Emergency Nursing.

I'm a student studying to get his RN at a community college but eventually I hope to go on and get my Master's and become an Emergency Room NP or maybe a Family NP and open my own clinic I'm sure I have the least amount of experience or knowledge on here about the subject but I would like to add something.

I don't think that anyone here is trying to say an NP = MD (or at least they shouldn't be) and I don't think that anyone is claiming that the level of medical knowledge is the same either (as long as your comparing practitioners with the same level of experience.) I think most of us know on this board that healthcare is so much more than just medical knowledge. I think the knowledge of nursing is also a huge part of healthcare that sometimes is underestimated by physicians. And we can all agree that nursing knowledge is something that a nurse practitioner has plenty of experience with. With those things in mind can we agree to disagree...

The letters MD do not distinguish someone as some sort of demigod, physicians are human beings just like the rest of us and they are capable of mistakes (as are nurse practitioners.) You will find that there are some very good physicians who are all about their patients and providing the best care possible and you will find that there are physicians who aren't so great for one reason or another (their ego, lack of common sense etc.) But the same can be said about nurse practitioners, you will find some really great NP's who do justice to the profession and there will be some nurse practitioners that aren't what you would expect (with some of the same flaws that "bad" physicians have.) One thing I have noticed in many discussions on the scope of practice for nurse practitioners is that some people seem to make it a war of physicians (or physicians assistants, PA's) versus nurse practitioners and I don't think that's right. Physicians and Nurse Practitioners are part of a medical team, each with their own responsibilities and scope of practice, they work together to provide the best possible care for their patients while working off each others strengths. Suppose you have a physician and a nurse practitioner that work in a clinic together and while the nurse practitioner may ask the physician to consult on an irregular lab result or difficult diagnosis the physician might ask the nurse practitioner to assist with counseling the family of a patient with a particular diagnosis. It really shouldn't be a competition for who outranks who and who and so forth. Despite the disagreements in this discussion, I'm sure you will find that in many (any probably most) cases nurse practitioners and physicians are able to collaborate to provide the best care for their patients with little debate. I think that the future for nurse practitioners is a bright one because of our ever-growing need for highly trained and capable individuals in the healthcare field, especially in the area of nursing. I know that there is also debate among healthcare professions because some people believe that the scope of practice for nurse practitioners is “creeping into physician territory” (as some would put it) and they fear that in the future the problem will only be worse. But personally I think that with our healthcare system changing and evolving as it is, what’s required of nurses, nurse practitioners, physicians, physicians assistants and just about everybody else in the healthcare field will require evolving and more “out of the box” thinking. I’m sorry if I got a bit off topic. Feel free to comment.

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Specializes in Telemetry, ICU, Psych.
I'm a student studying to get his RN at a community college but eventually I hope to go on and get my Master's and become an Emergency Room NP or maybe a Family NP and open my own clinic I'm sure I have the least amount of experience or knowledge on here about the subject but I would like to add something.

I don't think that anyone here is trying to say an NP = MD (or at least they shouldn't be) and I don't think that anyone is claiming that the level of medical knowledge is the same either (as long as your comparing practitioners with the same level of experience.) I think most of us know on this board that healthcare is so much more than just medical knowledge. I think the knowledge of nursing is also a huge part of healthcare that sometimes is underestimated by physicians. And we can all agree that nursing knowledge is something that a nurse practitioner has plenty of experience with. With those things in mind can we agree to disagree...

The letters MD do not distinguish someone as some sort of demigod, physicians are human beings just like the rest of us and they are capable of mistakes (as are nurse practitioners.) You will find that there are some very good physicians who are all about their patients and providing the best care possible and you will find that there are physicians who aren't so great for one reason or another (their ego, lack of common sense etc.) But the same can be said about nurse practitioners, you will find some really great NP's who do justice to the profession and there will be some nurse practitioners that aren't what you would expect (with some of the same flaws that "bad" physicians have.) One thing I have noticed in many discussions on the scope of practice for nurse practitioners is that some people seem to make it a war of physicians (or physicians assistants, PA's) versus nurse practitioners and I don't think that's right. Physicians and Nurse Practitioners are part of a medical team, each with their own responsibilities and scope of practice, they work together to provide the best possible care for their patients while working off each others strengths. Suppose you have a physician and a nurse practitioner that work in a clinic together and while the nurse practitioner may ask the physician to consult on an irregular lab result or difficult diagnosis the physician might ask the nurse practitioner to assist with counseling the family of a patient with a particular diagnosis. It really shouldn't be a competition for who outranks who and who and so forth. Despite the disagreements in this discussion, I'm sure you will find that in many (any probably most) cases nurse practitioners and physicians are able to collaborate to provide the best care for their patients with little debate. I think that the future for nurse practitioners is a bright one because of our ever-growing need for highly trained and capable individuals in the healthcare field, especially in the area of nursing. I know that there is also debate among healthcare professions because some people believe that the scope of practice for nurse practitioners is "creeping into physician territory" (as some would put it) and they fear that in the future the problem will only be worse. But personally I think that with our healthcare system changing and evolving as it is, what's required of nurses, nurse practitioners, physicians, physicians assistants and just about everybody else in the healthcare field will require evolving and more "out of the box" thinking. I'm sorry if I got a bit off topic. Feel free to comment.

Now THAT'S idealistic. Good post.

CrazyPremed

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Specializes in Emergency Nursing.
Now THAT'S idealistic. Good post.

CrazyPremed

Does idealistic translate into nieve? Its ok if it does, I'm here to learn. I know that I don't have alot of experience in the field or anything but from the few nurse practitioners I've met they have said that they haven't had that many problems while working with physicians. I'm sure what I said was idealistic but I don't think it was too far fetched, of course there will be problems and some tension but I think that physicians and nurse practitioners can be grown up enough to that aside to best serve their patients.

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Specializes in ICU, ER, HH, NICU, now FNP.

It is a great post - and while the situation as you describe it is ideal - it also is not unattainable or unrealistic. It all depends on the players who make up the team. People who set their egos aside on all levels and work well together to serve patients do a terrific job of exactly that.

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Specializes in Telemetry, ICU, Psych.
Does idealistic translate into nieve? Its ok if it does, I'm here to learn. I know that I don't have alot of experience in the field or anything but from the few nurse practitioners I've met they have said that they haven't had that many problems while working with physicians. I'm sure what I said was idealistic but I don't think it was too far fetched, of course there will be problems and some tension but I think that physicians and nurse practitioners can be grown up enough to that aside to best serve their patients.

Your post represents the relationship that quite a few mid levels have with their physicians. As you read many of the posts, though, you will find that there can be a sort of 'turf war' between the two. For example, some NP's here work in clinics where their pt's don't ever see the collaborating physician. The docs just sign off on their charts, and make themselves available when needed. The NP's handle seeing pt's, diagnosing, ordering labs and consults - pretty much everything.

I can understand where the tension comes from. When an NP is (in various situations) doing the many of the same things as a physician, but making $40,000-100,000 + less, or needs a physician to sign off on pt's that s/he never saw, tension is created. I think this is where most of it stems from. Is it justified? I'm still working on that answer. As you read the posts, and go through your training, you will have to make your own judgments.

CrazyPremed

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Specializes in ICU, ER, HH, NICU, now FNP.

I can understand where the tension comes from. When an NP is (in various situations) doing the many of the same things as a physician, but making $40,000-100,000 + less, or needs a physician to sign off on pt's that s/he never saw, tension is created. I think this is where most of it stems from. Is it justified? I'm still working on that answer. As you read the posts, and go through your training, you will have to make your own judgments.

CrazyPremed

I'd say that tension is alleviated quite well by the additional money made by the physcian! Several scenarios - The NP services are billed by the MD and the MD pays the NP salary, percentage or some combination but he gets the rest; OR the NP hires and pays the MD to be the medical director or collaborator. It isn't a losing situation for physicians at all - a business savvy NP & MD can both profit from the addition of an NP to a practice. And an MD who want's to move away from practice can profit from the services he or she provides as medical director. There is very very good money in it for the doc.

ETA: Some NP's resent the fact that they need a physician at all. Well in Texas, there are ways to not have one - open a rural health clinic in an underserved area.

I see what you are saying about the tension, however, I think a lot of that is lack of knowledge and understanding of business tactics - not practice issues.

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Hello group.

As a PNP with 18 years experience I find the Minute Clinic and such centers an outrage to our profession. Both NPs and PAs. Look into the history. The current president was the CEO of Arby's.

I just recently found out about these shops "cropping up" at the Walmart near you.

I am a legal nurse consultant and would not be found treating patients in this arena.

I just finished a busy day at the office--35 patients or more. The great thing is I had their medical records.

We are kidding ourselves if we think that CEO's can run a clinic and understand the ins and outs of practice.

It is not just colds that will be seen. And why don't they man them with interns or residents? HMMMM.

Case in point--my fellow pediatrician saw a child for bug bites. Found enlarged liver and child had ALL. Now, if we need to see patients as fast as possible (why not do drive through strep tests) do you think things will be missed? Absolutley. We are not in the Starbucks or Walmart business.

I feel we should stand up and refuse to be used by these corporations making money on our profession--and where will they be when that lawsuit arises??

I am a busy and happy NP--glad for my education--and will NOT be bought out by Minute Clinics. And guess what, you can invest in their business. Anyone out there work for one?

Just some of my thoughts. I welcome yours.

Joanne

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