IcanHealYou

Hi all I wanted to see what level of autonomy you have with your practices. I work in NYC part of a teaching hospital in a malignant hematology clinic. I work very closely with my attending. My primary role is to manage patients that are undergoing treatment. When I used to work Bone Marrow transplant I was allowed to do the full consult and write the note. I perform all necessary procedures unassisted as well. In your practice how comfortable are you making the diagnosis yourself and fully managing a patient without physician oversight? I understand in some states, including NY, you can practice independently. I personally believe there should always be physician oversight due to the complexity of some patients. Our differential knowledge pool is also much more limited from our studies. Thanks for your time.

Yea, thank God I have Up to Date st my disposal. It has all the standard of care for almost anything. And even has approached to many very common symtomatology and I feel students just don't utilize it enough.

I think many programs are starting to increase the number of hours of clinicals which is great.

Yea that's the thing. I think people should complain or things won't change. Its not a perceived lack of education, it's a fact that our education is inadequate. And it also takes someone who realizes this to make those changes to go above and beyond. You can read all the books and watch all the youtube videos (and I'm not saying you shouldn't) but medicine is still an apprenticeship. Nothing can compare to professionally guided learning. I've been trying to gain the perspective from both MDs and NPs to really learn the difference in education to close that gap. We definitely have our strong suits as nurses but let's face it. A lot of medicine is practiced a certain way for a reason and no route you take will really change the wheel that much. If we don't fully understand the underlying knowledge that MDs gain from their didactic and apprenticed learning I will have no direction on how to close the educational gap. From some MD perspectives they seem to believe that NPs can never attain a level where they can provide the same level of care as MDs can. Granted some of these are just arrogant a-holes but is there truth to it? I dunno but maybe, like i said, I'll gain more insight into this once I'm practicing. Luckily I know a lot of specialized MDs that'll allow me to practice with them and continue to learn even after graduating and working. The hours and self learning will take a long time but in family medicine I believe it's definitely needed. The array of knowledge is so vast. But this also brings me to another question. If NPs can practice independently are we still considered "mid-level" providers or is this term somehow made up to hold back the profession?

Thanks BC. I'm lucky enough to have a residency program available to me near where I live which I am most likely going to apply to. I really love primary care. I know the work is hard but I love the interaction, the education and just being able to help anyone with anything that walks through the door. I really wanna be ahead of the curve.

Oh wow I dunno why I never followed up on this thread. I am finishing my NP studies now and my feelings are still the same lol. I continue to feel that the task of family medicine is daunting and I am so not prepared with my measly 550 hours of clinical work. I definitely learned a lot but there's so much I don't know. I've been working with a doc and his thinking process is just superb. I mean you really have to know disease process, gross anatomy and just general indepth physiology along with many hours of application to really be proficient. If not for the MD I have been following my thinking process would not have been more directed. Just the simple idea of "how do you approach a patient with "this"" has helped me understand how to go through my differentials and not just toss them all in a hat. I feel like NPs are being taught the most basic standard of practice but if it comes down to something that uncommon or complex we just don't have the educational background to deduce answers. With experience you maybe able to do that if you've seen the situation before. But if it's something new , we just don't have the tools. Maybe once I've been practicing for years my views will change but for now, this is it. Will reassess.

Hey everyone, I am going to be venturing into the NP field soon and of course there are many things that worry me. We have great autonomy here in NY and so I am deathly afraid of practicing on my own. How exactly do NPs become proficient in what they do with such a steep learning curve? Medical students have 4 years of book learning and hours with patients. This to me can be easily remedied just by how proactive you are by reading and learning yourself. However residents get another 4 years of nothing but patient care. I've been a nurse for 7 years now and have learned a great deal. But the outpatient world is new to me. NP education is not standardized so its kind of a free for all depending on what school you attend. How exactly do new NPs learn to see what they don't know or have no experience toward? Unlike the inpatient world we can always refer to educators, colleagues or the medical staff you're working with. But in the outpatient world I don't believe you can just keep exciting the room every time you're unsure about something especially since other providers are swamped with their own work. Do seasoned NPs here have any advice or understand my concerns? I mean I'm just learning what a geographic tongue is on my own. There's so many benign things out how can an inexperienced NP know or not miss something important?

Yea, years ago when I was in the program they said they were going to conduct interviews but I never had one. I was actually wait listed and eventually was accepted. Just asking for someone I know that is applying. Do you guys think the interview process has finished?

Hey everyone, Does anyone know if they accept students without an interview? Or everyone that is considered a candidate needs an interview?

I haven't read the data myself to be honest. However from what I've read (on forums) and heard. NP can deliver great care if not better than some physicians. Again I havent read it myself but I think these studies may also have something to do with patient satisfaction and not really quantifying the competency of care. You can have an NP that prescribes Abx for a common viral infection. The patient will be happy and the end result will still be the same for the patient but with the risk of developing future abx resistance. Just an example, I'm sure most NPs would not be doing this. I haven't worked a day as an NP nor have I had any clinicals yet. So I am just speaking from what I know thus far.

Hey everyone, I'm sure this topic has been discussed many times but I have some specific questions. I am currently an FNP student and I have a strong passion for primary care. As I see it, this specialty is definitely challenging as you must pull your knowledge and be the front line to a patient's first sign of illness. My question is does FNP knowledge prepare you to take on this role? I never found the nursing education to be mentally stimulating and I know medical school is quiet rigorous and teaches the thinking process that is necessary to take on this role. I'm not trying to put down our profession, I am just worried and misunderstood as to how our education allows us to practice independently in some states. Can FNP adequately diagnose and manage succinctly without the waste of resources as well as MD can with experience? With all that can go wrong with the body and being the front line to diagnose and treat patients does our education allow us to perform without a disservice to our patients? Thanks in advance

I'm sorry to here this man. Our institution actually has started an anti-bullying campaign to raise awareness about these things. I hope things get better for you. Your mental sanity is worth a lot.

Welp, its now 2016. I just re-read all the encouraging and supportive words everyone on here has had to offer, which is greatly appreciated. I've left the ICU as I could not tolerate that toxic environment anymore. I am now working on a Bone Marrow Transplant Unit. Everyone here is extremely mature and friendly. I've finally found a place where I feel myself again and happy to go to work. I still love my career! lol

So I guess this university is pushing for DNP. This is really scaring me... I DO NOT want to spend an extra 2 years in school with added tuition. This is really disheartening. Fairfield University School of Nursing Frequently Asked Questions for the M.S. in Science, Family Nurse Practitioner Track

Hmm at what point can you be grandfathered in if it does go through? As long as the program starts before 2015 or you must have been licensed before 2015? It's 2013 now and I'm just applying to school this year. So if I'm lucky I may be able to start this fall and should finish just by the end of 2015.