"Family physician Amy Townsend, MD, first learned of Optimum Family Wellness in January of 2017 when a friend of hers, a physically fit man in his 40s, told her that he was going to be visiting the clinic.
Although the Nederland, Texas clinic was run by nurse practitioners, Townsend was initially unconcerned because her friend had no serious health problems and was simply seeking a refill for his routine thyroid medication.
But Townsend quickly grew skeptical when her friend showed her the slew of lab tests ordered by nurse practitioner Kevin G. Morgan even before an initial office visit -- a panel of nonspecific hormone tests including a C-peptide, growth hormone, prolactin, and a random cortisol level, which added up to a whopping $6,500.
But more worrisome to Townsend were prescriptions that nurse practitioner Morgan had prescribed for her friend: testosterone injections and a higher dose of thyroid medication, despite the fact that the patient's initial labs were completely normal, including a healthy testosterone level of 696.
Worried about the risk of excessive testosterone, which is associated with an increase in heart attacks in men, Townsend called Morgan personally to discuss the treatment plan. "He was contrary and condescending to me, offering to 'send me literature' on testosterone therapy," Townsend recalled.
A family nurse practitioner, Morgan received his master's degree in nursing in 2013 from McNeese State University, a 100% online program. Morgan had neither the training nor experience to treat endocrine problems like thyroid disease or low testosterone. And to Townsend, he seemed unconcerned about the potential side effects of these medications.
Instead of continuing the conversation, Townsend asked for Morgan's supervising physician.
Texas law requires that nurse practitioners be supervised by a physician. Morgan's supervising doctor at the time was Marian Querry, DO. Querry, a general surgeon, did not have the same medical background as the nurse practitioner she supervised, nor was she a specialist in endocrine problems. She practiced at a location 150 miles away from Optimum Wellness."
I don't understand why the nursing guru's don't have any interest in improving the standards of our educational system. Are they all doing side gigs as on line instructors? Just anecdotal but a girlfriend's mother was recently admitted to hospital because of low Na and the patient had warned the NP that her Na tended to drift low but the NP insisted that patient take the Lasix, which resulted in the admission for saline drip. My own NP was only too happy to prescribe huge amounts of narcotics which resulted in her and her MD losing narcotic scrip writing privileges. Not sure a better education can stop this kind of stupidity but it can't hurt! The line that "well, they pass the exams at the same rates" doesn't fly because it just means that the board exams are too easy. If they have no nursing experience how are they supposed to filter out the critically ill from the run of the mill? They'd be the first to miss the healthy young person with a serious post-op complication because they've never actually seen anyone go south. I don't know if the above story will ever circulate among the public but it's just embarrassing that we ask so little of our own. I'd rather be taking advice from an experienced med-surg floor nurse any day.
There are schools that allow you to not have experience to start the NP program, Samuel Merritt is one of them, there was a student that started his program after me and was finished before me, I guess that’s all built into the program. I made a decision years ago that I wanted to wait before I started my NP program, I have been a nurse for 9 years. Most importantly though once I finished school I wanted to find a place where I could work with a Doctor that I trust. I am fortunate that I found someone who is willing to teach me what I need to know specifically for the specialty I chose. Not that I do not know things but with his experience and knowledge, working with him will make me so much better. I do believe that there needs to be requirements for admission and I do not think that every university should have an NP program. I did a lot more in my program than the other nurses that I work with who did their NP at other universities. The bottom line is that not all experience is good experience. Not all hospitals offer good experience. So regardless the outcome may still be the same as if they had no experience.
She is correctly saying that NP's should have actual experience as nurses before going on to advanced practice - at least a couple of years.
She is, also correctly, saying that schools should require said experience before accepting students as NP's.
I hope that she is contacting legislators to get appropriate legislation passed because it seems our profession is not regulating itself in this regard.
I do wonder about PA's as well. What kind and extent of exposure do they have prior to being unleashed on the public?
CRNA's have to have, I believe, some ICU or ER experience before CRNA school. At least, it used to be required. I guess it still is. And it is right that it be that way.
W ay back in the '70's, nurses could go to Anesthesia school without any ICU experience. But everything is so incredibly more complex today. I think the requirement of ICU before Anesthesia school is warranted. I wonder what CRNA's think? Does their ICU experience help them in A school?
Kooky: This is only meant in a spirit of "they're so cute when they're young:" The reason ICU experience wasn't required in the 70's was because ICU's weren't extensive yet. My 400 bed hospital had one with only 10 beds..medical and surgical together in one unit. Today it was be considered a toy ICU (but we did learn great observational skills). But by the time I went to anesthesia school I'd been a nurse for 9 years and did a year of ICU/CCU before I went to A school. I couldn't have survived unless I did that year. I already knew how to interpret a 12 lead EKG, titrate our ancient proto-pressors, make independent clinical judgements...all that stuff we learn experientially from taking care of thousands of patients. Yes, technically, CRNA school requires only one year of ICU but I have read that the average now is 3 to 5 years experience. When I went the average was 7-10 years. So no, you can't be a CRNA now without ICU experience. If we can require experience, why can't the other advanced practice nursing specialties? It's because the American Association of Nurse Anesthetists has made a decision NOT to compromise on this principal and only count actual OR case time in the total hours. Not just walking into the building and out without touching a patient.
srod79
20 Posts
There are schools that allow you to not have experience to start the NP program, Samuel Merritt is one of them, there was a student that started his program after me and was finished before me, I guess that’s all built into the program. I made a decision years ago that I wanted to wait before I started my NP program, I have been a nurse for 9 years. Most importantly though once I finished school I wanted to find a place where I could work with a Doctor that I trust. I am fortunate that I found someone who is willing to teach me what I need to know specifically for the specialty I chose. Not that I do not know things but with his experience and knowledge, working with him will make me so much better. I do believe that there needs to be requirements for admission and I do not think that every university should have an NP program. I did a lot more in my program than the other nurses that I work with who did their NP at other universities. The bottom line is that not all experience is good experience. Not all hospitals offer good experience. So regardless the outcome may still be the same as if they had no experience.