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Nurses ‘Doctoring’ Without the Doctor in Rural America

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tnbutterfly is a BSN, RN and specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

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When Murlene Osborne, a cattle rancher in western Nebraska, first became a psychiatric nurse she planned to start a practice in her tiny town with a population of 67 that was without the services of a psychiatrist within a 7 hour drive. At that time, a state law required nurses like her to get a doctor to sign off before they performed the tasks for which they were nationally certified”.

In March of this year, the state laws changed.

Nebraska became the 20th state to adopt a law that makes it possible for nurses in a variety of medical fields with most advanced degrees to practice without a doctor's oversight.”

As a result of this law, nurses with a master's degree or better no longer have to get a signed agreement from a doctor to be able to order and interpret diagnostic tests, prescribe medications and administer treatments.”

The laws which give advance practice nurses greater autonomy are especially important in rural states which are struggling to recruit doctors to the more remote areas.

The AMA is fighting such laws as this saying that nurses lack the knowledge and skills to diagnose complex illnesses by themselves”. On the other hand, nurses just want to have more freedom to perform the tasks that their licenses allow without getting a permission slip from a doctor — a rule that they argue is more about competition than safety. They say advanced-practice nurses deliver primary care that is as good as that of doctors” and that they are far less costly to employ and train than doctors and can help provide primary care for the millions of Americans who have become newly insured under the Affordable Care Act in an era of shrinking budgets and shortages of primary care doctors.”

To read the entire story, please go to Doctoring, Without the Doctor.

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Lev has 7 years experience as a BSN, RN and specializes in Emergency - CEN.

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Enjoyed the article!

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1,757 Posts; 31,934 Profile Views

I am an RN. I agree completely with the AMA's position. There is no substitute for the education and training a physician receives. I believe patients deserve to be diagnosed and treated by physicians. I hope the AMA are successful in fighting these laws.

Edited by Susie2310

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MurseJJ specializes in Neurosurgery, Neurology.

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I am an RN. I agree completely with the AMA's position. There is no substitute for the education and training a physician receives. I believe patients deserve to be diagnosed and treated by physicians. I hope the AMA are successful in fighting these laws.

Are you saying that NPs are not trained to diagnose and treat patients?

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292 Posts; 5,363 Profile Views

I don't "doctor". I am an advanced practice nurse who provides medical care within my education and scope of practice.

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KatieMI has 6 years experience as a BSN, MSN, RN and specializes in ICU, LTACH, Internal Medicine.

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One can name it "doctoring" or whatever, but if there is a job to be done and the people who are supposed, by their training, professional obligations and, heck, ethical standards to do it are flat out refusing to fulfill the said obligations due to absence of 5-star golf course within 15 min driving, then others will have to come and get it all done. If the latter ones will do it with, apparently, same or higher quality and better outcomes, then good for them and for the community they serve. With due time, money and respect will follow.

Sorry, docs. You can either continue to pretend that you are still living in a parallel universe and so making home calls and listening to people is below your high honor of having thise two letters after your last name, or come back and get your hands dirty.

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traumaRUs has 27 years experience as a MSN, APRN and specializes in Nephrology, Cardiology, ER, ICU.

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Full independent APRN practice cont to expand - hopefully soon to the entire 50 states. This is especially important in very rural areas where healthcare might be many hours away.

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FLAlleycat has 30 years experience and specializes in L&D, Women's Health.

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I will see my nurse practitioner ANY day before I see her "supervising" doctor. She actually takes the time to really listen to me. I absolutely love her! I've also worked in migrant communities where the nearest doctor can be an hour away, not that that matters because they couldn't get they couldn't get to the doctor anyway due to lack of transportation. Nurse practitioners have a different philosophy from that of doctors, and it shows.

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hope3456 is a ASN, RN and specializes in LTC, Psych, M/S.

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I live in a rural area...we have 2 obgyn docs that are quite obviously the " leftovers" that probably wouldn't make it anywhere they had competition. There is also a NP who does women's health visits. I just called to get an appt for my annual. The NP was booked a month out (I tried to get her first) but the Dr's schedule was wide open.

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292 Posts; 5,363 Profile Views

I am an RN. I agree completely with the AMA's position. There is no substitute for the education and training a physician receives. I believe patients deserve to be diagnosed and treated by physicians. I hope the AMA are successful in fighting these laws.

We have patients in our practice, like yourself, who prefer to see the physician. There are other patients who prefer to see me. A lot of our patients see both the physician and myself. The bottom line is that advanced practice nurses have been proven to provide health care on par with our physician colleague.

The AMA has trotted out the old tired excuse that physicians receive more training without ever being asked to prove that the amount of training results in better care. Do you really think that the Orthopedic surgeon I work with got anything out of his residency rotation through the cardiovascular ICU that he applies today? Of course not- he wouldn't read an EKG or intubate or sedate a patient now. Wasted hours. Between the two of us guess who has placed more central lines in the past 5 years?

If you choose to only see a physician I harbor no ill will toward you. All I ask is that if a patient chooses to see a nurse practitioner you afford them the same rights. Perhaps a quick review of the RNs role as an advocate for patient autonomy would be appropriate. You are forcing your personal (misguided) belief onto patients, that everyone should see a physician, and taking away the patient's right to make their own healthcare choices. You are violating foundational nursing ethics.

Do you know what you call the student who finishes last in their medical school-Doctor.

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2,074 Posts; 36,235 Profile Views

I thank God that APNs have independent practice in Alaska. They are sometimes the only folks available to very rural citizens. Their care is good and their patients deeply appreciate the skill and compassion of the practitioners.

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cinlou has 37 years experience as a BSN, MSN, RN and specializes in Emergency and Critical Care.

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I am an RN. I agree completely with the AMA's position. There is no substitute for the education and training a physician receives. I believe patients deserve to be diagnosed and treated by physicians. I hope the AMA are successful in fighting these laws.

I am so sorry you feel this way. My Primary Care Provider is a CFNP, and she is awesome, she spend time with me and if at anytime she and I felt that I needed to be referred to a specialist or physician this would be done. The NP fills a major gap in general practice medicine. Physicians want to specialize for the big bucks leaving general medicine lacking in care providers. I am a Director of an LPN program and she also works closely with me to help provide a quality teaching/learning environment for my nursing students. The reports I get from my students who attend Physician office/clinics tend to have a lower quality survey report.

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