Nurses are Not Doctors

Nurses General Nursing

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An article appeared today in the New York Times as a followup to a bill passed in New York granting nurse practitioners the right to provide primary care without the oversight of a physician. The authors of the bill state "mandatory collaboration with a physician no longer serves a clinical purpose and reduces much-needed access to primary care". The need for more primary care providers is due to the shortage of primary-care physicians, the aging boomer population, and the Affordable Care Act.

Although the president of the American Association of Nurse Practitioners feels that the current "hierarchical, physician-centric structure" is not necessary, many physicians disagree citing that the clinical importance of the physician's expertise is being underestimated and that the cost-effectiveness of nurse practitioners is being over-estimated.

Many physicians also feel that "nurse practitioners are worthy professionals and are absolutely essential to patient care. But they are not doctors."

What are your thoughts on this? Where do nurse practitioners fit into the healthcare hierarchy?

For the complete article go to Nurses are Not Doctors

No. I'm a nurse. You are in med school.

I ask again, why exactly are you here? I'm not saying you're necessarily unwelcome, I'm just trying to understand what exactly you get out of being here.

Im a resident but I'm here for the same reason as everyone else. I like discussion and I could easily sit in a room of all doctors and here their side but it is biased so I like to hear the perspective of all sides.

Specializes in Adult Internal Medicine.
Im a resident but I'm here for the same reason as everyone else. I like discussion and I could easily sit in a room of all doctors and here their side but it is biased so I like to hear the perspective of all sides.

FWIW, Agree or disagree on points, I think it's great you are here and involved in these discussions.

FWIW, Agree or disagree on points, I think it's great you are here and involved in these discussions.

Thank you. I swear I'm not here to be antagonistic. I'm post-call right now so I might be a ill cranky :) I'm here to learn the other side, offer one physicians perspective, and hopefully we can all have great discussion.

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
Im a resident but I'm here for the same reason as everyone else. I like discussion and I could easily sit in a room of all doctors and here their side but it is biased so I like to hear the perspective of all sides.

If you're a resident, why did you choose that username? Just curious.

Specializes in Adult Internal Medicine.

As an aside, I hope people that debate this topic have taken the time to understand the history of NPs and how NPs were first granted prescriptive authority, as I think it is important in the discussion about independent practice.

This predated the landmark study in 1994 by nearly thirty years.

Specializes in Oncology.
Again no one would argue that nurses and APNs dont know a lot but if you want to continue to insist on comparing yourself to interns and residents it looks really silly. Of course you are going to save the ass of an intern. It's their first year out of medical school. Residency is where you learn to be a real doctor, medical school is all the knowledge. I'm sure that intern would make a first year nurse look like an idiot as well. As a resident I get a good laugh when my medical students make mistakes or says something dumb but I can't honestly compare myself to them. It's like night and day. Same goes for comparing a nurse with experience to an intern... But if it makes you feel good inside...

In my specialty I'm still showing fellows the ropes, and often explaining things to consult attendings. It's not just interns who I'm saving asses for. In fact, it's never interns. But, if reminding yourself how much better you are than nurses makes you feel good inside...

If you're a resident, why did you choose that username? Just curious.

100% honesty that was my geeky screen name in college and I am so lame I can't think of anything more creative so I always use it. I wish I had an ounce of creativity but alas I don't. Sigh

Specializes in Anesthesia.
You mention this like it's a bad thing. Medicine is a team sport, always has been and always should be. Quality and safety improve when we (nursing, medicine, all other healthcare fields) work together. Any person that argues NPs, particularly NPs with years of experience, don't have a seat at that table then they are sadly mistaken. I think where we disagree is what seat it should be. By "taking the jobs of PCPs" it increases the adversary relationship between physicians and nurses/NPs and DECREASES collaboration. Without standardization and credentialing that emphasizes your ability to diagnose and treat (the focus of medical school not nursing) you hurt your argument.

FNPs are taking jobs that most physicians do not want. FP is considered the easiest residency to get for that very reason. NPs are filling a gap that physicians have left undermanned for years.

I don't think anyone is denying that all healthcare providers should work together, but the difference in opinion is that NPs/APNs do not need laws forcing collaboration/supervision especially when it is most often not needed. Forced collaboration adds nothing to the care of a patient, increases bureaucracy, and often just builds animosity between different types of providers.

Specializes in Anesthesia.
100% honesty that was my geeky screen name in college and I am so lame I can't think of anything more creative so I always use it. I wish I had an ounce of creativity but alas I don't. Sigh

I did the same thing. I have been a CRNA going on 5 years, but still use the same screen name WTBCRNA ( want to be CRNA).

Specializes in Anesthesia.

Nurses are always going to be last line of defense for patients. Physicians/providers can see dozens of patients in a day and trying to keep all of them straight is always a battle. Everyone is occasionally going to say, chart, and/or order the wrong thing but hopefully it will be caught before it gets to the patient. This is just a fact in our busy healthcare system. I have saved attendings, residents, staff, interns, nurses, CNAs, APNs etc. from making a mistake and I am sure they have all saved me at one time or another.

I like working with physicians. I, like most APNs, just don't feel there should be laws that restrict my independence especially when every study shows it is unnecessary, and does nothing to improve patient care.

Specializes in Cath/EP lab, CCU, Cardiac stepdown.

Disclaimer first: I'm just a nursing student.

I personally think that there isn't a problem with nurse practitioner being independent as there are studies showing that they have comparative results to physicians. The concern that nurse practitioners do not know as much as a physician due to differences in training and that they may inadvertently cause harm to the patient by attempting to treat them anyway is a valid concern but not a major one.

I believe that similar to how physicians make consults and referrals when they require help or an additional perspective, NPs will do the same thing. As a student it's already been drilled in my mind that if I need help go get help. And some people may think oh but what if they make mistakes? Well studies already shown that they have comparable results to physicians in states where NPs work independently, not to mention physicians also make mistakes.

And also as a side note, please stop using anecdotal evidence as your definitive proof people, because we can both swap horror stories of the physician or NP that we saw or heard about all day. And let's try to be classy and keep the insults down.

Specializes in Pain, critical care, administration, med.
This is just wrong. In every sense, I'm sorry. In order to get into American medical school, an MD or DO program, you need a bachelors degree. The course requirements you see are contingent upon completing a bachelors degree. You can't apply with just those courses and no bachelors degree. Please find any medical school (a real one, MD) that doesn't require a bachelors and I will shut up and disappear forever. That won't happen because it doesn't exist. There are some programs that have linkages where you can do a combined bachelors and medical degree in 7 years instead of 8... But this person still graduates from college with a bachelors and graduates from medical school with an MD. And they are rare. Maybe you are referring to foreign medical grads that have the MBBS but they are not as common in the average hospital (unless you are working in a community hospital that is kind of desperate and just takes all foreign docs) but the MBBS is the equivalent to a medical doctorate in that country. It takes 6-7 years to get so it's clearly not just a bachelors.

even if this was true, who cares about how much non-medical education you have? You could become a medical assistant with a doctorate in literature... Does that mean the medical assistant is smarter than you? Maybe. Better at doing that job? Not even close.

Lastly, as I stated in the last post, EVERY physician (MD/DO) has a doctorate degree. The MD is a doctorate. If you don't believe me here's trusty Wikipedia: Doctor of Medicine - Wikipedia, the free encyclopedia. This means, for those keeping score, an MD has 4 yrs undergrad + 4 yrs medical doctorate and then 3-7 yrs of postgrad training aka residency. We spend on average 8 yrs in school post secondary, which is 4 more than the typical BSN.

Feel free reed to disparage physicians, it doesn't bother me in the slightest, but at least have it based on opinion not completely erroneous facts.

I am not so sure why you are ignorant any only think you are right. I have done my research and fully aware of what the MD has.

First Wikipedia is Not a good source of information. My guess is your education did not teach you where to look for good reliable information.

Second- Mds do not receive a academic MD. Yes their title is MD but not in academic schooling. Their MD is derived from their clinical experience. It really doesn't matter but to you. I also was not talking about foreign schools. I can read and understand. I stAted a fact and you choose to see it your way. This is why nursing is the wAy it is. It doesn't really matter. This whole story started on a uneducated belief of a physician about NPs and it continues in this thread.

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