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Nurses are Not Doctors

Nurses   (96,302 Views | 579 Replies)

Brian has 16 years experience as a ASN, RN and specializes in CCU, Geriatrics, Critical Care, Tele.

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You are reading page 5 of Nurses are Not Doctors. If you want to start from the beginning Go to First Page.

francoml is a ASN, RN and specializes in Critical Care at Level 1 trauma center.

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Just look at the APRNs in the 16 opt out states. They practice independently and studies have shown that they have the same patient outcomes as MDs. Obviously they are not performing heart surgery but internal/family medicine isn't anything that an APRN can't learn.

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The Princess Bride- I don't disagree with the basis of your post; a doctor goes to school longer and receives more clinical hours.

I don't think anyone is suggesting NPs will ever replace the need for MDs. The argument is, "are they educated and competent enough to perform certain tasks that in the past was completed by a MD"?

I know 95% of the time when I visit my Family Care Practitioner, I'm seen by a NP. Most of my visits are for allergies, flus, stomach bugs, etc.. I feel very confident in my NPs ability to diagnose and treat me for these ailments. On the other hand, if Im having a more serious issue, I'll go see a Medical Doctor that specializes in that area of expertise.

As for a NP only having a Bachelors Degree???? What State are you referring to? My wife, who has 28 years of clinical experience in Women's Health as a RN/ BSN, is now working on her NP. The minimum requirement at the moment is a Masters Degree. I understand that is changing to a Doctorate Degree next year. She plans to specialize in Women's Health, I think she meets the clinical experience you mentioned above?

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Here.I.Stand has 16 years experience as a BSN, RN and specializes in SICU, trauma, neuro.

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What physicians are you referring to who are not MDs or DOs?

MBBS's (Sorry, I'm not PMFB-RN, but I work w/ lots of 'em!) ;)

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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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The article is a typical example of a doctor's point of view. We are the only ones, our years of training = quality, just give us more money because we're not getting what we think we're entitled to because of aforementioned. Only one difference her is that, according to "some research", conveniently not cited, NPs "tend" to order more MRIs and stuff - so that they can somehow "compensate" bleak spots in their training.

Now, I'd like to ask: who is to blame for an epidemic of prescription opioid abuse? Who orders (and does) all these "spine pain shots" which sickened and killed some few hundred patients quite recently without any credible evidence of providing any more benefits than placebo? Who initiated situation when every 1 school aged kid out of 10 is supposed to have ADHD (CDC - ADHD, Data and Statistics - NCBDDD) and therefore can be prescribed drugs with high addiction potential? Who initiated "research" encouraging prescription of statins for children for unknown periods of time and with no clear ideas of long-term side effects? (Use of Statins for Dyslipidemia in the Pediatric Population) Who, last but not least, authorizes open heart surgeries on patients with end-stage dementia, hip replacements for non-compensated diabetics and dialysis for patients who are practically in rigor mortis already???

I can continue on, and on, and on. And something tells me that most of that has nothing to do with "inadequately trained" NPs and a lot with MDs with their years and years of training and schooling.

If doctors would like to gain back their authority in primary care, they just have to begin doing the said primary care themselves. Not by sitting in cozy offices "supervising" and writing scripts, but actually spending time with patients, teaching them, coaching them and supporting them. In short, they have to do what they were successfully doing 50 years ago. If they are unwilling to do it, someone else has to pick up the slack and get the privileges.

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Here is my problem with comparing NPs to MDs:

THIS..............The low standards needed to enter NP school. You can have people attend these University of Phoenix-type schools and receive their NP license online with little to no previous RN experience or NP clinicals.

AND THIS.....lack of (or little) clinical hours. What is it, 600 clinical hours for NPs WITHOUT NP residencies? Most residents will get those six-hundred hours in eight months or less in their first year. .

And again....as a supervised part of a medical practice, NP's can be awesome. As Lone Rangers....scary. It comes down to the old addage that sometimes YOU DON'T KNOW WHAT YOU DON'T KNOW!

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IrishIzCPNP is a BSN, MSN, RN, APRN, NP and specializes in Pediatrics, High-Risk L&D, Antepartum, L.

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And again....as a supervised part of a medical practice, NP's can be awesome. As Lone Rangers....scary. It comes down to the old addage that sometimes YOU DON'T KNOW WHAT YOU DON'T KNOW!

Scary? And based on what?

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The title of this article is wrong from the start "Nurses Are Not Doctors", because, in fact many ARE, having earned a doctorate in nursing, the title "DOCTOR" comes along with that. For example: Phd and DNP degree holders are called "Dr.". However, these folks are NOT asking to be called "physician", which is where the confusion may be.

NPs practice withing a scope of practice for their area. If there is a complication, then they have to refer to a specialist. It boils down to practicing within the specified guidelines of a particular state, many of which are similar, but there are also many differences across state lines.

The Institute of Medicine's report, The Future of Nursing, has a recommendation to expand the role of the nurse practitioner to include the fullest practice in the scope of practice. This article did nothing to promote that collaboration.I am hoping that someone writes a strong rebuttal piece back, representing the nursing profession, particularly NPs, as the professionals that they are.

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klone has 14 years experience as a MSN, RN and specializes in Women's Health/OB Leadership.

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Someone, anyone....please show me an example of an NP program that doesn't require NP clinicals, as the PrincessBride and TrishMSN have claimed.

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blondy2061h has 15 years experience as a MSN, RN and specializes in Oncology.

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Back to the orginial article and discussion.......

The idea of NP's without a physician link deeply concerns me. I have observed exactly what the author of the NYT article describes.....overtesting and over-reaching due to lack of clinical knowledge and experience. I think that NP's as part of a practice are great. The general assessment and history, treatment of minor acute illnesses, and management of chronic disease are all well within the scope of practice of an NP, and frees up the docs for more challenging and difficult cases/patients.

Additionally, far too many NP's, although they do not claim to be physicians, seem to have an underlying "I can handle this" overconfidence in their skill set. Personally, I have worked with several NP's with this issue, and six weeks after a "clean bill of health" from a GYN NP, I had surgery to remove a 12 cm ovarian mass ( Found as an incidental finding after an ED visit with a kidney stone). Speaks to a lack of diagnostic ability that could have cost me my life.

So, I agree with the author....NP's in solo practice are scary (NOT talking about CNM's, who know the limits of both their patient population and daily interventions. Pregnancy is not a disease, either, although it CAN lead to complications requiring an MD level of training and competence). I wait the extra day at my PCP to see a doc, even if the NP has openings, unless I am 100% sure I know what is wrong and what the treatment is. (I am NOT an NP, my MSN is non-clinical).

Gynecological cancers are often easily missed and not caught until they are much larger than 12 cm. Further, it could have easily grown from non-palpable to palpable in 6 weeks. Do you really think seeing a physician at that visit would have made a difference?

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klone has 14 years experience as a MSN, RN and specializes in Women's Health/OB Leadership.

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Gynecological cancers are often easily missed and not caught until they are much larger than 12 cm. Further, it could have easily grown from non-palpable to palpable in 6 weeks. Do you really think seeing a physician at that visit would have made a difference?

This. If the NP did a bimanual exam, then she did her due diligence.

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applewhitern has 30 years experience as a BSN, RN and specializes in ICU.

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We have had some bad experiences with nurse practitioners. That said, we have had some bad experiences with medical doctors. There are good and bad providers, whether NP's or MD's. I agree the NP should work with/under doctors. I do want to mention that I worked with many people who went to medical school in countries other than the United States. One doctor from Russia told me that they only go to school for 10 years, then college is only 3 years, and medical school is only 3 years. They can become physicians at age 22! All he had to do in order to practice in the US was take an English equivalency test, and do a residency. I have also worked with doctors from the US who went to medical school in other countries, like Mexico.

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I agree. I think they can serve a purpose, but they haven't been through the rigorous education, including internship and residency, like physicians.

There's a term in Latin from the law, which I regret I cannot quote verbatim, but it means, "Everything you say is true; so what?"

 

The vast majority of routine primary care doesn't require all that vaunted "rigor," as evidenced by the fact that many studies show better outcomes (and more cost-effectiveness, better patient teaching, and higher patient satisfaction) from care by NPs for the chronic conditions that fill most of the appointment slots at PCP offices: minor illnesses, DM, COPD, CHF, well-woman care, well-child care ... I think it safe to say that an NP can recognize the need for referral to physician care prn. We can do that in hospitals, too. :)

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