Quote from UnitRN01
I'm seriously considering applying to either NP school or MSN in education. The liability issue leaves me wondering if the stress of being an NP is worth the effort. Do NP's function in their practice according to a standard of care algorithm? In other words, if you make clinical decisions based upon what you are taught in school, is the risk for making a mistake minimized? If I were to become an NP, I would want to have a standard to follow in order to make perfect decisions about someone's care! My goal is to provide the best and safest care possible, and not get sued, which I'm sure is everyone's goal! I'm basing my career decision on responses, so any and all responses are appreciated.
I think you need to read up on standard of care. It is not an algorithm. The most common definition is how a similarly qualified practitioner would have managed the patients care under the same or similar circumstances. It usually only applies in court. So as an FNP you would be responsible for how an FNP would have treated the patient. However with the claim for independent practice you are essentially held to the same standard of care as a FP physician (correct me if I am wrong Siri). The standard of care also varies by specialty and by location. The local community standard of care may be quite different from positions laid out by national organization.
Education does not end when you leave school. Just as a physician continues to develop their knowledge base both after medical school and residency so too must any NPP. So you would not minimize mistakes by following just what you learn in school. Ideally you will have a mentor for the first year or two in practice where the greatest danger of mistakes are.
When you talk about standard of care algorithms what I am assuming you are really talking about is treatment algorithms. There are good algorithms developed for a variety of conditions. There are also good practice recommendations for a variety of conditions. You should definitely understand the latest practice guidelines for the conditions you follow. If you choose not to follow a practice guideline you should be able to elucidate a reason why you did not. For example in the case of strep throat if you use an algorithm instead of testing you should be able to show why you believe this to be better. The good thing about medicine is their is usually more than one way to skin a cat. You should also know the what the local community does. On the other hand if you say it is OK of your diabetics to run A1C's of 11 because it is mean to limit their sugar intake you will have a hard time justifying this if something goes wrong.
The use of algorithms is another piece that is debated. The use of algorithms is well established. However, knowing when to deviate from an algorithm or establishing your own method of practice is what differentiates a clinician from a technician. You will eventually develop your own practice style, but differentiating disease states and rapidly formulating a treatment plan is the hardest part of practicing medicine (or advance practice nursing). Eventually it becomes second nature, but it is a very difficult concept for some people.
A final comment on risk or getting sued. You stated that you goal is to provide the best and safest care possible, and not get sued. You also stated that you want to follow a standard to make perfect decisions about someone's care. This is an impossible standard.
Getting sued realistically has no relationship to the quality of care you provide. People who were appropriately treated will have bad outcomes and sue. People who were inappropriately treated will have bad outcomes and not sue. There are a number of studies that show the best predictor of not getting sued is your relationship with the patient.
As far as providing perfect care, as long as humans are involved as either patients or providers mistakes will happen. Patients will die. Bad outcomes will happen. The best you can do is have sufficient processes in place to minimize mistakes.
Practicing medicine is very difficult. One of my classmates, who was the best clinician in class, quit 2 months before graduation because he could not deal with the fact that he might be wrong and the patient would have a bad outcome. It is not for everyone, but it is very rewarding if you can stand the heat.
David Carpenter, PA-C