Nurse Practitioners across the world

[XB9S, BSN, MSN, EdD, RN, APN]

I thought it may be interesting to get an idea of what different NP's do across the world. There have been loads of discussions about the differences between RN's in the US / UK and Australia so it may be interesting to do the same here.

The ANP role in the UK was mainly based within primary care but has been around for about 8 years in a hospital setting the UK so is still a fairly new role. In the hospital setting it is poorly understood by managers and was introduced to cope with the mandatory reduction in junior doctors hours to 56 hours then 48 per week (european working time directive) because it was introduced as a stop gap with little idea about what these nurses would be doing the nurse practitioners have been fairly independent about what the role became.

My team of NP's wanted to be linked directly with a consultants team which gave them a caseload of patients and direct responsibility for patient care. Not all roles took this approach, some worked as a emergency response team, some as ward based practitioners.

What I have found is that with a senior medic who has a vested interest in a nurse practitioner as part of the team development and support has been much more forthcoming.

[XB9S, BSN, MSN, EdD, RN, APN]

Just an idea of what type of things as a NP in the UK I would deal with.

I am based in a surgical unit and work with a team of 4 surgeons. The consultant, a Senior Registrar, Senior House officer and House officer. I deal with both emergency and elective patients and work withint the surgical wards and outpatient clinics.

A great deal of my role is about teaching, both the nurses on the wards and the junior doctors. Because our doctors work shifts ( a maximum of 48 hours a week now) there are occasions that I may be the only team member available and therefore have to work independently although the senior doc is always available on the end of a phone.

I am also a nurse prescriber and this is a seperate qualification which is registrable with our governing body the NMC, this allowed me to prescribe any drug listed within the national formulary with the exception of some opiates.

I like the autonomy of being a NP, and I love the teaching and supportive role that it has here in the UK. I love working alongside the junior doctors and supporting them when they are brand new out of med school, it is fantastic watching them develop into great doctors over the months that I spend working alongside them.

It is definately not about money in the UK as we don't earn any more than a senior nurse on a ward.

I love the diversity of my role, one day I could spend my whole time dealing with elective surgical patients who are waiting for surgery or are post op, then the next I can spend it in the emergency unit dealing with surgical emergency admission, admitting and then working them up if they need surgery, or I may do a bit of both during the day. I see them pre-admission, during their hospital stay, post op and in followup clinic so I love the continuity as well.

I am lucky in that my supervising doctor is brilliant, he is supportive and encouraging and respects the nursing staff who work with him

[JDCitizen]

Well as one can read on all these listings the business of being an NP here in the US varies from state to state job to job...

Myself :

I can best explain in bulleted format.

• State: Georgia

• Employer: State of Georgia

• I work under the old protocol system

• I don't do mental health medications or narcotics (believe me that is a good thing).

• We use a limited formulary.

• I order/ interpret test (labs),

• I can order MRIs, CT scans etc..

• I can order and follow-up on consults (for patients to see specialist / surgery).

• There are times when I get to do H&Ps and medical rounds.

• Suture and minor, minor surgical procedures...

So basically I am a gatekeeper....

When needed I refer or confer with my primary doctor. Sometimes after several visits I automatically refer for case review...

My doctor knows what kinds of cases I really, really like to work with and refers those patients to me...

We do not use computer based charting.

[XB9S, BSN, MSN, EdD, RN, APN]

Could I ask whats the old protocol system?

[traumaRUs, MSN, APRN]

Thanks Sharrie for the insight. In the US, we have so many types of mid-level practitioners that we all come under the umbrella term of "advanced practice nurses" or APNs. I'm an adult health clinical nurse specialist.

I work in a large nephrology practice. Most of my day is spent taking care of problems with chronic hemodialysis patients. I see them, examine them, diagnose them and prescribe meds, tests and then interpret everything once it comes back.

I also have call which is a misnomer because I have to see pts in two hospitals about 55 miles away and most of them are in the ICU.

[JDCitizen]

Could I ask whats the old protocol system?

Yes you sure can and I will be more than happy to explain sort of because it's complicated. Here in Georgia APRNs are now basically regulated by two entities (neither one set up for the protection of the nurse):

- Georgia Board of Nursing (Licensure authority for nurses set-up to protect the public)

- Georgia Board of Medicine (APRNs essentially kowtowed to the Medical Association of Georgia to get prescriptive authority). Licensure authority for doctors and for all practical purposes run by doctors..

There is basic statutes in each brand of protocol mandated by the state:

- Under the old protocol system the pharmacology is limited but the ordering of procedures is not as limited...

-The new protocol system expands the pharmacology ordering potential but limits the ability of diagnostic testing...

There is more to it but that is the jest...

Since my practice everyone works under a limited formulary my prescribing is not really limited per say except for mental health and narcotics. I don't shy away from narcotics when my patients need them it's just that those orders get an immediate counter sign (sort of like hey doc this guy really needs the T3 please sign).. Mental health medications are handled by the mental health professionals....

Since I am a provider as well as gatekeeper to care the ordering of test (x-rays, MRIs, etc.) is essential.. Don't get me wrong I am not reading the films a radiologist / specialist does that but when I want to look at the actual films I do (I have a great relationship with the radiologist)... But I do really, really like the fact I have the ability to interact in my patients care with specialist in other fields of medicine... Every case does not need a specialist / consult but when one does I make the call....