practice without physician involvement?

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does anyone know any data about which states nps can practice in without any direct physician involvement? i find sites that have all different answers and have looked everywhere. help!!!!! :confused:

I don't think its about getting together collectively as NPs. Its perception. I feel as though I am a medical provider in as much as I admit, write orders, diagnose, place lines, and provide ongoing medical management. I'm not a nursing provider at this point in my career. I provide medical management of patients.

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I agree with PICUPNP I consider myself a medical provider, not a nursing provider at this point.

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Specializes in ER; CCT.
I feel as though I am a medical provider in as much as I admit, write orders, diagnose, place lines, and provide ongoing medical management. I'm not a nursing provider at this point in my career. I provide medical management of patients.

I'm curious, when a dentist writes orders, diagnoses, prescribes and manages the patient, do you think this is the practice of medicine and the dentist is a "medical" provider and not a dental provider? How about when an optometrist prescribes, or a when a physical therapist prescribes a physicial therapy regimen, or when a dietician prescribes a dietary plan, or when an occupational therapists prescribes a rehab plan--do you consider these medical providers too, or are they health care providers practicing within their own discipline?

When a physician performs a function which is considered the practice of nursing (physicial assessment, psychosocial assessment, patient educuction) do you consider the physician to be a nursing provider? Or, do you recognize that certain functions of disciplines do overlap with one another, and the provider is known as a member of her or his profession, depending on the model and framework that guides the disciplines practice?

By saying you are not a nursing provider, does that mean you reject nursing tenets, nursing values, nursing theory, nursing paradigms and nursing framework in the nursing profession in which you are licensed and credentialed and assume the medical allopathic model to guide your care in a profession in which you are not credentialed?

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Absolutely! I have never found myself using any of the nursing theories, paradigms, or frameworks in managing any of my patients. I manage patients medically. I have my own values and tenets to guide me. I have never found in 13yrs where any of that helped me to manage a patient., but the advanced physiology, pharmacology, embryology, etc that I received in NP school help out constantly.

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Specializes in ER; CCT.
Absolutely! I have never found myself using any of the nursing theories, paradigms, or frameworks in managing any of my patients. I manage patients medically. I have my own values and tenets to guide me. I have never found in 13yrs where any of that helped me to manage a patient., but the advanced physiology, pharmacology, embryology, etc that I received in NP school help out constantly.

How sad. So, just so I'm clear--as a member of the profession of nursing:

You reject the nursing framework that posits that human beings are more than the sum of all of their parts (Martha Rodgers)--and feel that human beings are only a collection of signs, symptoms and clinical cues, as provided by the reductionist medical-based allopathic modle.

You reject the concept that our function is to assist the individual, sick or well, in the performance of those activites contibuting to health or its recovery (or to a peaceful death) that the patient would perform unadided if he had the necessary strength, will or knowledge (Virginia Henderson).

You reject the notion that we must place our clients in a cultural context which guides care delivery across ethnic boundaries (Madeline Leininger) to enhance care and prevent cultural injury.

You reject the concept that human beings are in constant state of biopsychocial changes, and our role is to aid the individuals adaptation of those changes (Callista Roy)

You reject the concept that self care is an integral part of maintaining optimal levels of health (Dorothy Orem)

You reject that a major function of providing care is enabling the patient to adopt active health-seeking and health promotion behaviors (Nola Pender)

I could go on and on, but I must say, this is truly sad. Since you reject the nature of nursing so much and feel it has little to offer in providing a guiding framework with which to care for people, have you considered changing to the medical profession such as physician or physician assisting where nursing tenets and nursing values are not central in directing nursing-based care? Perhaps, though, you are comfortable just operating with the profession of medicine and borrowing central theories from nursing, as many medical providers do, while maintaining nursing credentials.

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Specializes in ER; CCT.
I have never found in 13yrs where any of that helped me to manage a patient., but the advanced physiology, pharmacology, embryology, etc that I received in NP school help out constantly.

Could you let us know which NP school you say you went through that had embryology?

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I don't find any of that useful in MY practice. I find that treating people with dignity and respect has always worked out for me. As far as my NP school, it was the University of Pennsylvania. The textbook was Langman's Medical Embryology..9th ed.

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I don't think its necessary to use all of that in order to better treat patients. It's so much simpler to treat people as human beings instead of prescribing to all of the numerous nursing theories out there. As far as being a PA, I wish that I had gone that route simply because the education and clinical time is superior to NP school. Oh and no theories!

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i don't think its necessary to use all of that in order to better treat patients. it's so much simpler to treat people as human beings instead of prescribing to all of the numerous nursing theories out there. as far as being a pa, i wish that i had gone that route simply because the education and clinical time is superior to np school. oh and no theories!

how does deal with practice without physician involvement? the constant bashing of np education, nursing theories , and wishing you had been a pa is confusing. numerous threads lately asking for information have been hijacked by several individuals, who post on how bad nps education is, and how they want to take over, ..... please find another fourm to discuss how nps are so awful.

back to the thread, i have been a fnp practicing in a rural clinic for over 25 years. in those 25 years i have never had a md on site, this is often the nature of a rural clinic. i have had a collaborative agreement, signed by the md who receives a fee for collaborating with me from the parent organization. which is a great deal for the md, since i rarely collaborate with him/her. in the past 15 years, i may have called an average of once a year. the response each and every time was "ok". what are they going to tell me? don't transfer, don't refer? they are not at the clinic, they rely on my judgment.

most often the rural collaborating md is there for a year or two, meeting obligation of the nhsc, visa or other economic reason. thus, rural patients figure it out, stick with the np for continuity of care or drive 60-80 miles for a md in the city.

i do have a lot of physician involvement with specialists, thank goodness! i send them off to the speciality, and they return to me for management, better known as primary care.

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I will continue to espouse my opinions just like everyone else on this forum. I am not bashing NPs, I am one.

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Specializes in ER; CCT.
I As far as being a PA, I wish that I had gone that route simply because the education and clinical time is superior to NP school. Oh and no theories!

It is never too late to change. If nursing is not serving you or your patients, perhaps switching to the medical field might be a more favorable and inline with your system of beliefs.

Your views are sure consistent with the medical establishment and its powerful lobby to deny access and place barriers to patients access to nurse practitioner care. Perhaps a career in the medical lobby might be more suitable than staying in a profession in which its values, tenets and philosophies you so wholeheartedly reject.

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Specializes in ER; CCT.
how does deal with practice without physician involvement?

unfortunately, the comments made by picupnp, and many other bashers of np's, np education and np practice underscores a belief system that is the largest barrier to patients access to np care resulting from physician supervision mandates, which is central to the op's question.

to be clear, the medical establishment would love nothing more than for np's to abandon their nursing roots, nursing heritage, nursing philosophies, nursing theories and adopt the notion, as stated by picupnp, that we are medical providers and not nursing providers. this operation would essentially marginalize nursing and at the same time, maintain that np's, like pa's, belong to the field and discipline of medicine. if np's are within the field of medicine, then physicians--not nursing--dictate the direction and advancement of the provider.

although i'm sure picunp, and many others, do not see their comments as damaging to nursing and patients access to care, there are many np's who are proud of our nursing profession and see ourselves as more than medical technicians in what we can offer to our patients. in short, some of us are our own worst enemy when it comes to our profession and the advancement of patient's access to health care.

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