Jump to content

Nurse practitioner vs Medicine turf war?

Posted

As someone who is entering the field of nursing with the goal of ultimately becoming a nurse practicioner after gaining experience, I have noticed a lot of "turf wars" and arguing going on between nurse practitioners and physicians.

Nurses said doctors have an issue with it because doctors feel aprns are treading on their turf, and doctors claim aprns are trying to take over their jobs and scope of practice with independent rights with much less training... I can see it from both sides.

Then there is the whole nursing model of education vs medical model of education that Nurse practitioners claim to practice and state that it is more holistic so they claim it makes them a different type of practitioner justifying the independent rights.

But a big question of mine is, when it's all said and done, isn't "advanced practice nursing" really practicing medicine? At that level it's no longer nursing but medicine. It's medicine thats regulated my nursing boards so it's called nursing. And at that point the "nursing model vs medical model" is to me irrelevant, because when youre practicing medicine it's medicine regardless of the model u claim to follow... theres guideline's and protocol. For instance, if you are diagnosing and treating a UTI, it's going to be the same regardless of if you are a NP with the "nursing model" vs a PA or MD with the "medical model"

So can anyone give me insight?

NurseGirl525, ASN, RN

Specializes in ICU.

Do you understand the difference between the nursing and medical models?

Yes, the nursing model is said to be more hollistic.

I have noticed a lot of "turf wars" and arguing going on between nurse practitioners and physicians.

Where have you noticed these turf wars and arguing? Possibly in places where someone manufactures and 'us versus them' debate?

There is no turf war in the facility that I work at. NPs can be hospitalists and work with an MD (collaboration agreement). They get the stable patients.

An NP told me the other day that NPs have more time for patients when they work in a medical practice as compared with the MD.

In my personal opinion there are of course huge differences between the education that physicians get including residency and the NP education. But - despite the differences in education and training, it seems that NPs do a great job though I have noticed that NPs who never worked as RN seem to lack some important experience.

I work with MDs and NPs and have no problem with one group or the other. I have not noticed that the nurses and physicians do not get along - actually it seems that everybody respects everybody, which includes all employees....

NurseGirl525, ASN, RN

Specializes in ICU.

Yes, the nursing model is said to be more hollistic.

No. That's not it. The medical model treats the disease. The nursing model treats how the person reacts to that disease.

I think you see holistic as the all natural medicine free way that those herbalists push these days. That couldn't be further from the truth.

First, you need to understand the difference in how nurses practice and doctors practice. It's taught your first semester of nursing school.

Then, come back and talk about these turf wars you read of on the internet.

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

Welcome to AN. Everyone comes to nursing with different expectations and reasons. Overall, most new nurses are more idealistic then those that have some years experience - at least in my experience.

That said, I've been an APRN for 10+ years now and see no issues working with doctors. They respect me and treat me as an equal colleague.

I personally don't feel nursing is all about being "holistic". Maybe 30 years ago when nurses had fewer responsibilities and a lower knowledge base it was "holistic" but nowadays the nurses I work with are sharp, keep up to date and know the science behind their care. And...if they don't they ask questions.

I haven't seen a "turf war." In my facility, the physicians appear to loooooove having NPs to do most of their work for them. :rolleyes:

KatieMI, BSN, MSN, RN

Specializes in ICU, LTACH, Internal Medicine. Has 7 years experience.

In fact, there is a turf war. It is going on systemic level, and physicians are losing it on primary care level. Otherwise, there wouldn't be hysterical articles about "settling up for a nurse" which appear here and there quite regularly.

The problem is, the revolution in healthcare which started around start of twentieth century brought up problems nobody expected. A hundred years ago, 85 y/o was expected to sit in a favorite armchair, read fairy tales to kids and say blessing on Christmas morning. Now we see octagenarians demanding the same opportunities and quality of life as if they were still in their 60th. 50 years ago there were no question about conception issues for people born at 24 to 30 weeks or surviving cancer in childhood because there were only so few of them around. There was no question of dealing with people having half a dozen of mechanical and electronic constructions imbedded into their bodies forever and taking 30+ meds daily, half of them to correct side effects of the second half, and still demanding full, wholesome life free from any restrictions whatsoever. In addition, the regulatory bodies already spewed more screening and prophylactic recommendations, guidelines, protocols, etc. than a human body or any country's economy can bear, and they are not about to stop any time soon.

The net result of all that is dramatic increase in routine healthcare work that has to be done somehow. As American Medical Association and its professional leagues continue to shoot themselves in feet and other parts by stubbornly refusing to eliminate "bottleneck" of residency training and thus increase number of available providers while continuing to support price gouging in medical education, the job just physically cannot be done by those providers that available. Can you imagine yourself looking carefully for every single spot on naked humans, immediately pinching out anything suspicious, for 8 hours a day for roughly $50/hour while having over $200000 in college debths? That is what CDC wants dermatologists (who, due to high stakes in residency, have to go through high-level and therefore most expensive schools) to do in form of "skin cancer screening", for every American, once a year. And it is approximately as realistic as zombie apocalypsis happening right now. But it still has to be done even if not for everybody. So, there are now "residency programs" in clinical dermatology for APRNs who will gladly do it for said $50/ hour. One is free to argue that, since skin screening thus done by nurses, then it becomes "nursing" rather than "medicine". But the baseline stands as it is the job that has to be done, and there are no enough physicians willing to do it for monetary compensation offered. And so it will continue in every area of healthcare, whether anyone likes it or not.

There is a turf war. No doubt about it. Look what happened in Ohio when NP's lobbied for independent practice last year. The AMA threw up their heads and howled. Here's the fact: I am not a doctor. I am an NP. Are there things that are beyond me. Of course. We are not asking to be doctors. We are asking for independent practice as Nurse Practitioners. We are not trying to take over medicine or push them out of the picture. We will always need doctors and their expertise. Many of them resent NPs. Many of them do not.

As NP's we practice medicine. I do not practice nursing. I medically manage patients and treat them medically. The more 'holistic' part is in the way I approach the patient. As a nurse, I was taught to make a partnership with the patient and for mutually acceptable goals. I bring that over with me in practicing as an NP. I have noticed that physicians approach patients from a more paternalistic view. They want to dictate the patients treatment and expect them to just follow it. I will explore how the patient feels about the treatment and look into any barriers like: lack of money, social issues, family issues. Do you see the difference in my practice? It is a strange hybrid of a nurses demeanor and love of caring and a physicians practice of medicine. Frankly, it makes for better care and is much more patient-centered.

Having said all of this, you want to keep one thing in mind. Be very careful where you accept a job as an NP. In the ER where I work, NP's are loved and esteemed. The physicians I work with are an incredible group. They treat me as their colleague and afford me the respect of a provider. God help you if you come down to this unit and yell at me or treat me in a less than respectful manner. They will be all over you so fast, you won't know what hit you. They even ask my opinion about treatments and EKG's all of the time. I am very, very lucky. In this same hospital there are NP's who are treated like nothing more than scribes. I asked around, sniffed around and did a lot of research before taking this job. Make sure you are going to work with doctors who will respect you and let you practice at the top of your license.

Jules A, MSN

Specializes in Family Nurse Practitioner.

I asked around, sniffed around and did a lot of research before taking this job. Make sure you are going to work with doctors who will respect you and let you practice at the top of your license.

Well said and I also advocate for using your nursing connections with physicians when looking for NP opportunities. And as always don't take the aforementioned $50 an hour especially as a NP who went through a derm fellowship. I could give a rats patooty if thats "the monetary compensation offered". Employers need to be realistic and offer appropriate wages especially if NPs are billing at 85% of the physician's rate. IMO part of being respected as a professional is learning how to negotiate your duties and compensation like a professional rather than settling or little more than RN wages and minimally elevated RN duties.

Buyer beware, BSN

Specializes in GENERAL. Has 40 years experience.

Well said and I also advocate for using your nursing connections with physicians when looking for NP opportunities. And as always don't take the aforementioned $50 an hour especially as a NP who went through a derm fellowship. I could give a rats patooty if thats "the monetary compensation offered". Employers need to be realistic and offer appropriate wages especially if NPs are billing at 85% of the physician's rate. IMO part of being respected as a professional is learning how to negotiate your duties and compensation like a professional rather than settling or little more than RN wages and minimally elevated RN duties.

And speaking of a "rats patooty" stop spewing out NPs from the rat's patooty allowing those who control the means of production to TELL YOU, "$50 bucks, take it or leave it."

Edited by Buyer beware
w

Jules A, MSN

Specializes in Family Nurse Practitioner.

And speaking of a "rats patooty" stop spewing out NPs from the rat's patooty allowing those who control the means of production to TELL YOU, "$50 bucks, take it or leave it."

I think I want to "like" your post but haven't had enough of my Starbucks yet this am to be sure I'm following you. If you mean NP schools need to be way more selective in who they admit and that if someone presents a job offer as "take it or leave it" we should leave it, then I love your comment.

FWIW I have and will continue to do the second point because I tell them how much I will need to make if they want to bring me on and they can "take it or leave it" which is nicer language than the words inside my head. Of course those days might come to a screeching halt as all the new grads buck for my job at half my established rate. The sad truth is although my reputation is excellent most employers could give that rats patooty if someone is even competent if they have the credentials and Lord knows nursing has no shame about giving anyone the credentials who can pay the check and pass a few multiple choice questions.

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 14 years experience.

Moved to the NP forum.

Data consistently shows np outcome superior to MD outcomes in Many factors if not equal... We need to tear down the MD gods who have zero competition in their profession. This is a capitalism, market based economy. The skilled tradesman and master cottonweavers are irrelevant to our current economy. Soon we will see that these highly trained doctors are overtrained and not needed when a more cost efficient and effective option exists.

Honestly some postings on here serve no purpose other than to stir stuff up and offer nothing of value.

So far I have seen no "turf wars". Most MDs in training are realizing that primary care is not worth it for them and they go into a more lucrative specialty. So thats where NPs and PAs are filling the gap. So in reality we are not taking their jobs. As far as practicing, as an NP you are taught to use the most up to date evidence based guidelines not so much a holistic approach. NPs still have their nursing background so yes it does come into play. I feel having a nursing backround as opposed to medicine gives you an advantage of looking at the patient as a whole. Incorporating all aspects into their plan of care.

Aromatic

Has 3 years experience.

Data consistently shows np outcome superior to MD outcomes in Many factors if not equal... We need to tear down the MD gods who have zero competition in their profession. This is a capitalism, market based economy. The skilled tradesman and master cottonweavers are irrelevant to our current economy. Soon we will see that these highly trained doctors are overtrained and not needed when a more cost efficient and effective option exists.

lol lol