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

#488- I agree that not all programs are created equally. A person should research the school they are considering attending to be sure it offers a quality education. As for a NP researching a diagnosis online, I don't have an issue with that at all. In fact, my doctor routinely refers back to his books when diagnosing a patient. He has a general idea of what he thinks is wrong, but he is competent enough to verify his initial assessment. I'm in a transitional phase (educationally speaking) right now. I've been an aircraft mechanic since 1988 (still am), and not only do we refer to the Maintenance Manuals to support our own "hunch" when a system on the airplane is not working, we are required to do so by the FAA. If I take one panel off of the airplane without an open Manual sitting beside me, and a FAA Inspector walks by and sees it, I'm subject to not only a fine, I could lose my license. That should be a comforting thought to all passengers, just like a MD or NP researching their own "hunches" while diagnosing a patient should be comforting to that patient. In fact, look at all the APPs these days that are designed for MDs that do just that. As for Google, who amongst us hasn't used it while taking classes?

Specializes in Nephrology, Cardiology, ER, ICU.

Lets get back to the topic at hand PLEASE!

It would be a shame to close down this very popular thread due to one or two individuals who can't debate the topic, not the poster.

Please keep this professional.

#488- I agree that not all programs are created equally. A person should research the school they are considering attending to be sure it offers a quality education. As for a NP researching a diagnosis online, I don't have an issue with that at all. In fact, my doctor routinely refers back to his books when diagnosing a patient. He has a general idea of what he thinks is wrong, but he is competent enough to verify his initial assessment. I'm in a transitional phase (educationally speaking) right now. I've been an aircraft mechanic since 1988 (still am), and not only do we refer to the Maintenance Manuals to support our own "hunch" when a system on the airplane is not working, we are required to do so by the FAA. If I take one panel off the airplane without an open Manual sitting beside me, and a FAA Inspector walks by and sees it, I'm subject to not only a fine, I could lose my license. That should be a comforting thought to all passengers, just like a MD or NP researching their own "hunches" while diagnosing a patient. In fact, look at all the APPs these days that are designed for MDs that do just that. As for Google, who amongst hasn't used it while taking classes?

Well said!

But when a nurse has to google whether white tonsils are a symptom of strep or post nasal drip, it's just a little nuts!

I think the jest of this topic has evolved into a debate over the educational differences between a MD and NP and should NPs be allowed to practice autonomously? I am of the opinion they already do in many different environments. Sure, most have consulting physicians they work with, but when the rubber is meeting the asphalt, they are often working alone. The consult generally happens after the initial interface with the patient and the diagnosis & treatment have been rendered. In some more extreme cases, the NP may order tests and call the consulting MD before proceeding with treatment. I'm of the mindset as long as the NP understands the scope of their limitations, there is nothing wrong with this. Also, the recent changes in HC Policies almost dictate a more advanced role of the NP.

#520- I would think a strep test would be in order whenever someone shows up with those symptoms.

Specializes in Anesthesia.
Talk about someone who is complaining about me giving anecdotes...Lol... Anyway you made my point about these FM residents--that was why they were 'residents'--not full-blown physicians.

And who do you think the idiot attending was? Do you think it was a janitor that signed off on the diagnosis? The point anecdotal evidence is everyone has some, but it is hardly research and is pointless to bring it up when there is plenty of research to guide EBM/EBP.

Specializes in Anesthesia.
Duh! :)

No one ever thought that doing well on a standardized test had any correlation to how an NP will fare in her profession

BUT

it does effectively weed out the students who aren't bright enough to really be NP's

And if occupational therapists need to take the GRE's to get into their graduate level programs the NP's certainly should as well

Why should we follow research on one thing and not another? There isn't any correlation between how graduate nurses will do based on their GRE scores (despite personal opinions) so why keep utilizing an ineffective method to evaluate potential graduate nursing students.?

Specializes in Adult Internal Medicine.
You guys think your bogus studies along with screaming 'equal outcomes' from the roof of a tall building will make it so...You might fool some people with these nonsense, but you won't fool people who know about medicine... None of you have answered the concerns of that poster (post #487)...

I would much rather scream from the roof of a tall building about the growing body of peer-reviewed major studies than stand in the street and cry about how it must be a conspiracy.

You don't know about practicing medicine. You are a student.

27 pages in and what have we learned? Who has changed their mind? You can spout off credentials and anecdotes all you want but as far as I know you are all a bunch of janitors at walmart. I can read peer-reviewed articles and judge their applicability myself. So far I haven't seen any objective data to indicate the APNs are unsafe or unqualified. Comparing curricula doesn't prove anything. Both engineers and mechanics know how to rebuild an engine, by gluteus's logic only engineer education is sufficient to to rebuild engines.

27 pages in and what have we learned? Who has changed their mind? You can spout off credentials and anecdotes all you want but as far as I know you are all a bunch of janitors at walmart. I can read peer-reviewed articles and judge their applicability myself. So far I haven't seen any objective data to indicate the APNs are unsafe or unqualified. Comparing curricula doesn't prove anything. Both engineers and mechanics know how to rebuild an engine, by gluteus's logic only engineer education is sufficient to to rebuild engines.

I know it's a race to the bottom.. As long as you can come with stupid studies that claim 'equal outcomes' (whatever that is), these legislators will make you become physician-like... However, they will demand care from a physician when their love ones are sick... I guess the fake physicians are for the masses...

Specializes in Anesthesia.
I know it's a race to the bottom.. As long as you can come with stupid studies that claim 'equal outcomes' (whatever that is), these legislators will make you become physician-like... However, they will demand care from a physician when their love ones are sick... I guess the fake physicians are for the masses...

And when have you taken care of any Senators or Congressmen loved ones?. I have taken care of both and neither one requested a physician. Unlike you I trained at "The President's Hospital" in Bethesda Maryland where VIPs were the norm everyday, and I never heard of one of them request a physician for their care.

You choose not to believe any of the studies on quality of APN care, but can you explain why the most well funded medical groups cannot perform one research study to refute any of the quality of care APN studies?

Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
I know it's a race to the bottom.. As long as you can come with stupid studies that claim 'equal outcomes' (whatever that is), these legislators will make you become physician-like... However, they will demand care from a physician when their love ones are sick... I guess the fake physicians are for the masses...

My mom is an OB/GYN-NP and CNM. She has a NUMBER of physicians who come to her for care. She even sees physicians from the group she works for...her own physician colleagues chose her for care. So what makes you think the legislators are going to run to physicians is physicians aren't running to physicians? Seriously question. The group she is with is very large with a number of doctors. If an NP was so awful....why would the other MDs pick the NP for care?

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