markdanurse

Hello all! I just wanted to put in my 2 cents here regarding this mandatory BSN issue. There are many other fields that accept an associate's degree to perform the job successfully in healthcare (i.e. respiratory therapists, radiology technician, radiation therapist, ultrasound technicians, echocardiographers, MRI technologists, Nuclear medicine technicians, etc.) Sadly, many of these jobs I've just listed make as much as, and in some cases, more than RN's regardless of the RN's preparation level. I don't see anyone pressing those groups to go back to school to get a BSc or BA degree to continue to do their jobs. Most people would contend that these people do their jobs just fine without the almighty bachlor's degree. I would also like to point something else out. Why can't we have multiple points of entry into our field? Why do we have to be like everyone else's field? What's wrong with being unique or individual? I am proud that I work with people from varied backgrounds. I work with new rookie RN's in their 20's. I work with the 43 year old mid-career changer. I work with the business owner who decided he wanted to give something back and became an RN. All of these RN's are great people and even better nurses. You don't need a BSN to be unified! All RN's and LPN's can unify no matter what their educational levels. Look at plumbers, electricians, carpenters, etc. These occupations have unions (at least in my state). They make good money and have good benefits. But most importantly, they stick together and are recognized as experts in their fields. Electricians work with dangerous materials that could kill them or those around them if not properly set up, repaired, or used correctly. Being a plumber has it's own complications too, as does being a carpenter. Maybe we should make these occupations get bachelor degrees too? I think it absolutely absurd that some professions have gone to a doctoral degree. Come on now! To be a pharmacist requires a doctoral degree? Please! To be a physical therapist or an audiologist requires a doctoral degree? Why? Even occupational therapy is going to a doctoral degree! These professions do not have a broad scope of practice. In fact, their SOP's are rather narrow and limited. But heck, if we can squeeze huge student loans out of people and make them spend years in school so they can call themselves "doctors", then why not? Thank Heavens nursing isn't like that! Embrace your profession! We are unique! We are important! The level of educational preparation does not define us! Nursing can organize and achieve respect! Respect isn't given, it's earned!

Okay, Uhhh, $75,000 a year in Florida for a master's prepared social worker? That does not sound right. I know of no entities that pay that much for an MSW. A psychologist holds a PhD of PsyD in the field, not a master's degree. And you would be hard pressed to find a psychologist who makes that much in the field, unless he or she was in private practice, university professor position, or in a government position. Most behavioral health/ social welfare degrees do not pay that much. In my state, the MSW's in my hospital make less than an ADN prepared RN. If your sister does make that much, then she is the exception to the rule. (And good for her!)

Someone mentioned the ADN vs BSN motto gain. They were right...we can't seem to get nursing to agree on one academic entry level. But now we have the AACN deciding the DNP must be the minimal entry level requirement for APN's. But have any of you heard of their new proposal that a master's prepared generalist nurse, called a clinical nurse leader (CNL), should be the new entry level requirement into "professional nursing"...NOT the BSN? It's true...just Google it. Just another level of absurdity that nursing does not need right now. ADN programs cannot go away, as we are facing a huge nursing shortage pretty soon here. We need all of the RN's we can muster within the next ten years. It takes 83 - 89 credits to become an ADN at most of the community colleges in the state where I reside. It is not a typical 60 credit associate degree. The fact is, many of the students who come out of the community colleges seem to be just as bright and competent as the BSN graduates...many times even more technically competent than their BSN counterparts. Nursing doesn't need more managers. It needs more competent bedside nurses. I guarantee if the other professions were facing our shortages, they wouldn't have gone from baccalaureate to doctorally prepared education like they did. More educational requirements is just another way to weed more people out from getting into many of their programs. Nursing is not in a state to be so selective and intellectually elitist. Besides, I have met many people with those ADN's who have bachelor and master degrees in other fields and are quite happy with where they are in life. Mark

I agree that a 4 year Doctorate of Nursing anything should not be considered a "quick'n'dirty" doctoral degree. But a DNSc, DNP, ND, DNS, etc. is not anything close to a PhD. A PhD is a research based degree and requires a dissertation. A dissertation, especially in an area deemed important to the field of nursing as determined by academia is extremely difficult, time consuming, and well...mind boggling. The other nursing doctoral degrees generally do not require such serious research and then the extremely difficult dissertation. The only reason we have all of these degrees is because the lack of universities willing to accept nursing science as a real entity like biology, chemistry, astrophysics, etc. So in order for the schools to get any type of doctoral degree, the nursing programs had to accept a degree name other than the PhD. In many universities, other schools within the university actually repressed nursing when nursing schools applied for PhD charters. I personally believe that a doctor of nursing practice should not be the requirement for entry level APN's. Writing a bunch of papers will not make a better clinician. It will not help a new graduate NP feel more prepared for the real world. NP school should be competency based, not paper-based. What makes PA's so successful is that they are inundated with both theory and clinical practice and are taught to be clinically competent. They generally don't write nearly as many fluffy papers as the NP schools make you do, and they don't make PA's study so many irrelevent topics like NP schools do. They get to the meat of it. Either way, expect PA's to still make more than even the DNP-prepared NP's. Medicine doesn't embrace nursing's fluff when it comes to healthcare. It embraces hardcore science, and that's what PA's deal with. How many of you know what Pharmacists do and have shadowed them? How many people have shadowed OT's, PT's, Audiologists, and other "doctorally prepared" healthcare professionals? Well, I have. And in my time, I have seen absolutely no evidence that anything these other groups do require doctoral level education. Look at their scope of practice. Look at what their daily activities are. What they do is not rocket science. Look at this for what it really is... another way for a group of professionals to call themselves "doctors" and another way for universities to make more money. How does having a bachelor's degree in another area, and then going to school for 3 to 4 years further make a person more clinically competent than when these programs were at the bachelor's level? When these programs were at the bachelor's level, they made you take a ton of very difficult science and mathemeatics courses, and then you got to the good stuff. You had to be very bright with an excellent GPA to get in. You spent 5 years in school learning what you needed to know instead of 8. Let's get real here. Oh, and then we get the we need more education because things have become so much more complicated. Nope. Doesn't fly with me. We see many of the same diseases we have dealt with all throughout human history. Then we see some new ones. The difference is how we treat the diseases now as opposed to the past. Technology has not made our jobs more difficult. It has made our jobs much easier. Need to know anything about a drug or a medical disease you haven't heard of? Just whip out your PDA. Need to keep track of those VS? Just go to the Trends Review section on the monitor. Need to know what the normal range of the lab values are? Just click on a tab on the pt's computer-based chart and there you go. Having trouble making a differential diagnosis? Just place some s/sx in the laptop computer, and some new diagnoses you may not have thought of pop up. Need to make sure your drip rates are correct and within safe limits? Just access the computer on the IV pump with the pre-programmed drug information and voila! It's all a matter of perspective. Critical thinking can occur at any academic level... not just the doctoral one. this is just one RN's opinion...

David, This is what I like about the PA profession versus the NP profession. Your profession does not knock the educational levels of the members of your profession and is not demanding a single entry level requirement to practice. I like the fact that there are certificate, associate, bachelor, and master degree PA programs. All of them have their use. For example, a military corpsman with 20 years of experience will have a huge array of medical knowledge and thus a certificate or associate level PA would fit nicely for him. Why should he have to go to school for 6 to 7 years to get a Master's degree in PA Studies when he has so much life experience? Why not have a bachelor degree PA school available for those who want their first bachelor degree to be in PA studies? Why not have master degree PA programs available for those who already have a bachelor degree in another area? You don't see the PA profession demanding that all schools go to a DScPA degree like you see nursing do. Even if it did, I don't think there would be a movement to change every single program to a doctoral level. Bottom line is, regardless of your previous academic experience, PA school is HARD. You either perform, or you're out. It matters not at what educational level you enter into PA school, it will be at least 2 years of pure academic rigor. Dummies generally don't graduate. The only thing that has changed educationally is the prerequisite requirements to go into these schools. I am not impressed by a PA student having a bachelor degree in psychology, elementary education, or business. Most of the classes in those degrees do not apply to what you must know in PA school anyway. In fact, when I applied back in the day to a Bachelor of Medical Science PA program at a local private university, students were accepted in over me into the program even though I was an LPN who worked almost daily with PA's at an inner city ER. (And yes, I had a 3.9 GPA and all the classes the school required.) After my interview, I received a letter of rejection a few months later. When I called the school to ask about the rejection letter, I was told the other students were more qualified academically. Again, only 6 seats out of 90 were given to students who applied with no degree or an associate degree. I did not agree that a school teacher, business major, or psychology major was more prepared for PA school than a practicing nurse to enter into a BMS PA program. I also felt the practice of accepting people into a bachelor's program when they already had bachelor degrees or higher cheapened the process, as there were plenty of seats in the MMS program to apply for. The point I'm trying to make here is that more is not better. Often times, more is simply just, well... more. I knew I had the intelligence, background, and muster to hold my own with any of those students who did get accepted. Why shouldn't a really bright diploma or ADN RN with many years of experience be able to go to school for two more years and become an NP? Why does it HAVE to be an MSN (or soon a DNP) to gain entry into the profession? Again, too many hoops, too much nonsense. But thank goodness the PA profession gets it. I have met some certificate and associate degree PA's in my career who could do circles around their supervising physicians. I find it sad that the NP profession does not grasp the same concept. Competence is more important than credit hours. Mark

Hello again. I just thought I'd point out something. Being that we are in the world of "evidence based practice", what empirical evidence did the AACN provide in the position paper it sponsored regarding the need for a Doctorate of Nursing Practice for all advanced practice nurses to enter into the field? What research was conducted? Did the AACN send out a survey to currently practicing NP's to ask them about whether or not this DNP degree would be a good idea? Did it send out a survey to physicians, hospital administrators, or allied health professionals asking their opinions? I have read the AACN's DNP paper, and I say to you, the answer is "no". There is absolutely no empirical evidence showing this change is needed or even necessary. Read between the lines of that paper, and here is what you should be reading: 1.) Other professions have a doctoral degree to practice, so we should too. We need to be like other professions such as pharmacists, lawyers, optometrists, etc. They are respected because they are all doctorally prepared, right? Instead of embracing nursing's uniqueness regarding entry into practice, we have adopted the same concept as, "Hey, everyone else is doing drugs, so we should too." 2.) We will produce more doctorally prepared educators by requiring the DNP as an entry level requirement into practice. Never mind that academia cannot pay a PhD educated nurse what she or he is worth right now, and she or he can make much more money working as an APN or nursing administrator than as an educator. Never mind that a DNP prepared educator may not be granted tenure because the degree is not seen as equivalent to a PhD. Also, there is more difficulty in obtaining tenure as a professor in a university's school of nursing than with most other schools within the university. Don't believe what I'm saying here is true? Do your research...there are articles plastered all over the Internet. 3.) We can command more respect from physician's, other healthcare worker's, and patients by claiming all APN's are doctorally educated. I hate to say this, but I have seen plumbers, linesmen, and electricians command a great deal of respect, despite the lack of a college degree. Why? They are EXPERTS in their fields, they can BILL independently for their services, and they do not carry subservient stigmas that nursing as a "profession" has. A doctoral degree does not command automatic respect, especially if it is watered down. (And yes the DNP does not even compare to the MD/DO in terms of level of difficulty and clinical hours.) We all know medicine is based in intellectual elitism. We all know there will be a group of APN's who get this degree for nothing more than a stroke to their egos. Life is about cost-benefit analysis. People have to live...that requires making money to sustain a lifestyle. I find it amusing that nurses want to get the degree for the "enjoyment of it" or to "enhance their studies". There are really inexpensive ways to enhance one's studies other than a DNP degree...it's called continuing medical education. Requiring people to get into huge student loan debt, and to spend yet even more of their life in school, to make less money than most other practice doctorates currently out there, and see no significant financial or increased scope of practice returns, is absurd. Critically think this one out using logic, cost-benefit analysis, and research. You'll find that perhaps the DNP really should be just an option, and not a requirement for the APN. I look forward to your comments. Keep in mind that I do not wish to convey that those who wish to obtain the DNP should not. I do wish to convey that again, it should be a choice and not a requirement.

Let's not attack the original poster of "nurses are pathetic" message. Let's be honest, we are. We do take abuse. We are mistreated. We are underpaid. I joke with people and tell them I had to go to college to be treated like dirt. I used to work as a stocker/cashier for Fry's Food and Drug. If a customer mistreated me, they were asked to leave. In an 8 hour shift, I was given two 15 minute breaks and a 30 minute lunch break. If a manager mistreated an employee in front of a customer, he was taken upstairs to a private office, talked to, and then written up. Our benefits were cheap and wonderful. The company put aside 50 cents out of every dollar an employee earned and put it towards a 20 year retirement. We were protected by a UNION called UFCW Local 99. The UNION represented the workers. The UNION made sure we had retirement, affordable and excellent benefits, good pay, and wonderful working conditions. I left that job to become a nurse. Yup. Nurses have NO IDEA how other jobs treat their people because many of them haven't done much else in the way of work, especially corporate or union work. Now how is it that a Cashier/Stocker with a high school education or less can have such a great opportunity but nurses do not? Answer: Nurses are pathetic. Nurses have not learned how to get along, like we did in kindergarten and grade school, so that they could demand things like a real pension plan (not a 401K), affordable and excellent benefits, safe patient ratios, actual breaks throughout a 12 hour day, and respect from managers and physicians who are held accountable for their behavior. Can you imagine a physician or manager being told,"If you don't start treating our staff with respect or dignity, we will revoke your privileges at this hospital or fire you?" It is possible, but nurses will not do it. You may all attack me as much as you want. Deep down, you have all felt the way the original poster did, and using synonyms like "apathetic", "codependent" or "weak" really doesn't cut it. Pathetic is a correct term. I tried to start a union once, but the nurse "rats" ran to management and "told on me" like kindergartners do, and I was asked to resign, which ultimately I did. They griped every day for a year about the deplorable working conditions, so I offered a solution. And what did they do? They did nothing as usual, except get me "fired" so-to-speak. Band together, and the hospitals will have little choice but to meet your demands. Keep doing what you are doing as a profession...oops, I meant occupation, and everything will remain the same. Including the term "occupation"...because we do not behave as true professionals do.

Do BSN's think that nursing education is any easier for the ADN nurse? Yes, there are less useless prerequisite courses for the ADN. Yes, ADN's do not take Community Health Nursing, Statistics, or Research in Nursing. ADN's do take many exams, attend quite a few clinical rotations, are expected to hold their own with BSN level nurses, and are held to the EXACT same standard clinically as a BSN. I've never studied harder in my life than when I went to an ADN program. And I have a bachelor's degree in another area. My instructors were strict and concise...you knew your stuff or you failed out. Period. End of discussion. I don't appreciate being talked down to by a BSN, especially because our education is so similar. I precepted BSN new grads. I taught them quite a bit despite my little ADN title. I have never had a physician ask me, "Are you a BSN or an ADN?" Physicians do not care. In fact, nearly every patient I have come in contact with does NOT care. We are all in this together. I don't respect a BSN any more than I respect a diploma or associate degree nurse. I worked side by side with an MSN-prepared nurse in an ER. She was very good, but the physicians and other nurses didn't treat her any differently. Why should they? Her title is RN. Also comes the "two year RN" title. I love this one. Try 3.5 year RN...yes, with tons of prereqs and the actual school itself, I earned many more credit hours than just 60. Then let's discuss the "BSN's have a better patient safety record than the ADN" issue. This percentage, in ONE study, quoted a decrease in medication error and mortality rate of 10%. Really? In what area did this study take place? In what setting? How many ADN's and BSN's were involved in the study? What statistical methodology was used? How many patients with bad outcomes were studied? The point is, statistics can be dead wrong, have no true significance, and can be altered to support the researcher's hypothesis. Don't believe me? Read the book "How to Lie with Statistics". I was a manager with an ADN, but now I must have a BSN degree? Please. The BSN's working under me hated that fact and felt I did not belong in my role because my BSc was in something else. But I precepted most of the nurses working with me! Talk about absurd. I don't hate BSN's. In fact, I applaud their decision to become BSN's. I just want them to realize experience is everything in this field. As well as continuing education. And I don't mean spending another $12,000 to $20,000 on a BSN. I mean actual continuing education courses on how to be a better bedside nurse (i.e. ventilator courses, PICC line courses, I.V. therapy courses, assessment courses, legal documenting courses, etc.) By the way, my BSc degree is business related, with a heavy emphasis on managerial skills and finance. But I wouldn't make a good nurse manager, because my degree doesn't read "BSN". Anyone else see the absurdity of this?

Hello fellow nursing colleagues! I thought I'd discuss some nursing issues that frankly, I find quite disturbing. Some of what I'm about to say may be inflammatory, but do not think for a second that I'm singling anyone out or a particular group out. Let's talk about the AACN. This group does not certify or accredit any nurses. It is essentially a think tank that nursing leaders are using to make radical changes in the profession. Unfortunately, very little input is taken from actual clinician nurses into their views before the organization spews forth its ideas. AACN has decided to make all advanced practice nurses obtain a doctorate degree called the Doctorate in Nursing Practice (DNP) in order to meet entry level requirements for practice by the year 2015. Guess what?! The University of Washington implemented the requirement 8 years early. that's right, as of this year the MSN no longer cuts it for NP education as of this year at that university! This is a four year degree AFTER a bachelor's degree to become a CRNA, NP, CNS, or CNM. This is absurd, as many people choose to become NP's to circumvent medical school and not spend so much time and money into becoming a healthcare practitioner. I believe this is a waste of time because this degree will do nothing to increase the scope of practice for an advanced practice nurse and according to studies, the master's degree in nursing has prepared APN's just fine. (Read JAMA if you don't believe me.) Now comes the next concoction, the Clinical Nurse Leader. This is a master's prepared nurse that is a generalist doing many of the same functions that a CNS already does. Furthermore, it is proprsed that this position will be the new minimal entry requirement for professional nursing. What??? Why??? The BSN will no longer be the minimal entry level requirement for professional nursing? I have researched this position extensively and see very little use for this clinician in real clinical practice...something that I think our current "nursing leaders" seem to be in denial about. BSN's will no longer be at the top of the food chain. Why are these changes being made? Well, inferiority is one reason. Well PT, Pharmacy, Audiology, Law, etc. have done it...so why shouldn't we? Well, because nursing is not like these other professions! We should celebrate the fact we have different methods for people to become nurses. Nursing is flexible, unlike our rigid ancillary counterparts! Plus, we have a major shortage of nurses, and those other fields don't have a shortage of professionals. Why do we need to be like them? Let's be unique! We keep going for this "more is better" approach to nursing preparation. Yet nursing is going downhill fast. Why? Because we all just can't seem to get along. BSN's talk down to ADN's and diploma nurses because the nursing leaders say this education is inferior. Well, now the CNL/MSN prepared nurses will talk down to the BSN's, ADN's, and diploma nurses. Then the PhD, DNSc, ND, DNP (four doctorate degrees in nursing...good grief!) will then talk down to the MSN,BSN,ADN,Diploma nurses. This is called intellectual elitism, and nursing sees it at its finest every day! Guess what? We are ALL RN's. And despite what others may think, the eduaction is VERY similar, minus 3 to 4 classes taken at the BSN level that is not taught at the ADN or diploma level. Let's stop bickering and get along, shall we? Now to really get you thinking. Nursing, since its inception, has relied upon the field of medicine. Nursing cannot exist without medicine unless you are one of those APN's who can practice independently. The idea of a PhD in nursing science is absurd based on a field that is controlled or dictated by medicine. Nursing is subservient to medicine, whether we like it or not! Look at what an audiologist, physical therapist, optometrist, lawyer, etc. does. These jobs have a very limited scope and skill set. Do you really think it takes a doctoral degree to do these jobs? Answer, NO! People did them just as well, if not better, when these positions were at the bachelor's degree level. But everyone wants to be a doctor of something! Why? We don't call these people "doctor" when we work with them. The APN will not be called "doctor" when he or she gets the DNP degree. Scope of practice didn't change for any of these groups when they had the doctoral degree forced upon them. So what's the point again? oh yeah, increased tuition to the universities and more title related ego for the nurse with low self-esteem. It's just one nurse's opinion. What's yours? Speak up and let me know. Mark

All right my fellow professionals. Are we getting caught up in the whole "more education means more respect and more professionalism" thing all over again? I have worked side by side with physicians for years...11 to be exact. And I have yet to have a physician, or even a patient ask me, "Are you a diploma, ADN, or BSN nurse?" Why? Because it does not matter. We all pass the same licensing exams, we all pretty much learn the same material minus some community health and management courses, and we ALL have the same scope of practice as an RN. So NO, more education does not equal more respect and professionalism. Please stop with this argument...it is nothing more than a logical fallacy. In fact, education has become a joke. A doctorate degree is needed to become a physical tharapist or a pharmacist? Please. These two professions have such a narrow and limited scope of practice that it is almost ridiculous. When I worked as a pharmacy technician, I did the pharmacist's work for him. (i.e. filled the scripts, called physicians for prescription refills, mixed IV medications in piggybacks and 1 liter bags of IV solutions, alerted him to level 3 or higher drug interactions, and much more. He would come by, double check my work, and sign off on the labels.) The only things I could not do was counsel a patient on how to take medications, and I could not accept a new order from a physician. I made $24,000 a year, he made $90,000+ a year. Some of the smartest pharmacists I have met are those with the old B.Pharm (bachelor of science in pharmacy) degrees. Oh, but all pharmacists do the exact same job regardless of their degree. Yet, no one is forcing those with the bachelor's in pharmacy degree to go back to school for the Pharm.D. degree. See my point here? On orthopedic rehab units, I worked with physical therapists all day long. I also worked with associate degree trained physical therapy assistants. Yet, you couldn't tell the two apart when they were working with their patients. Having friends who are PTA's, they explained they can do everything a PT can do except initiate a plan of care, do the initial assessment, and cannot do wound debridement. Interesting that you would need a doctorate degree to do those three extra skills. Yet I have worked with bachelor degreed physical therapists and no one forced them to go back to school for their DPT degree. Why? Well, it's a neat concept called grandfathering. Those that have been practicing for years do not need the same level of knowledge as the new grad just entering the profession. I do not wish to be forced into a degree when I do not wish to go into more debt for school. Pay me an extra $4.00 an hour for my BSN, and I'll go back to school. Otherwise, the continuing education I constantly go through in my nursing position, as well as my specialty nursing certification, and the CE's I get through nursing journals more than prepare me to give safe care to my patients at the bedside. Then we have my favorite issue... the 4 year, post BSN, doctorate of nursing practice (DNP or DrNP) requirement for all entry level advanced practice nurses (i.e. CNM, NP, CRNA, CNS). Yes folks, in the AACN position statement, by the year 2015, all programs will offer the DNP instead of the MSN degree for entry into practice. And why is that? Well, research has shown that NP's at the current MSN level are more than competent and capable of achieving outcomes the same as, and even better than their physician counterparts (i.e. as written in JAMA). It's because the profession thinks it will achieve more respect and professional recognition because it will offer a doctorate degree to its clinicians. Yet, having spoken to many physicians about this, most of them laugh and ask, "Why do you need that? Most NP's do just fine at the current master degree level? Why go through just as much didactic as a physician only to make less money and have a scope of practice that still does not parallel a physician. (i.e. NP's still do not do surgeries, and still cannot do 100% of what a family physician can do) Why not just go to medical school?" Yet, NP's will be grandfathered in regardless of their previous educational level (yes, we have diploma,ADN, and BSN advanced practice nurses still practicing out there from before the time of the MSN hooplah...none of them were forced to get their MSN degrees.) Well, because we like to follow logical fallacies such as "more is better" and "if we have a doctorate degree, physicians and patients will respect us more", and "physicians will have to take us seriously then", etc. Welcome to the big expensive joke...more education = more respect/professionalism.

Hello fellow professionals, May I have your attention please. An allnurses.com user by the name of nursebrandie made a valid point in the emergency nursing subforum that I would like to discuss with all of you. We were discussing the use of paramedics in the ER, and it was mentioned that the two professions were interchangeable. This is alarming to a professional nurse such as myself. We must not give give up our career roles to other specialties. Any of you that do not believe this is an issue, please consider the following: 1. Anesthesia started out being administered by nurses, that's right, nurses...not physicians. Nursing gave this role up to physician anesthesiologists. Yes, we still have the CRNA profession, but now there is a new role out there called the Anesthesiologist Assistant (AA). It is a master's degree program that physicians created to keep the midlevel anesthesia providers under their thumbs. The position pays as well as, if not more than, a nurse anesthetist. 2. Physical Therapy and Occupational Therapy started off as subspecialties of nursing. Yes, PT's and OT's were orginally nurses that received specialty training in the activities of PT and OT. But we gave these positions away too and now the PT has become a clinical doctorate degree and the OT has become a master's degree. 3. Midwives originally birthed babies, not physicians. In fact, the first known male physician to witness a live birth dressed up as a woman to see the event, and when it was discovered, he was burned alive at the stake. Yes, we still have nurse midwifery, but it never should have been given to the male physician group. And also look at what CNM's get paid compared to OB/GYN physicians...for pretty much the same job. 4. RN's used to be able to mix drugs in piggybacks for I.V. administration. Now pharmacists have completely taken over that arena too. Why is this important? Well, just this...did you ever need a drug in an emergency situation, like Mannitol, but had to wait for a pharmacist to mix it and you get it back in 30 minutes when you could have mixed it in 5 minutes flat? Look around you...nursing's skill set is being taken away, but our nursing leaders are demanding us to have more education. Why? Nurses aren"t smart enough to use strict aseptic technique to mix drugs in an emergency situation? 5. Why is it that nurses cannot endotracheally intubate except in an ambulance or flight nurse role? Why is it that a paramedic can put in an EJ IV line, central line, or chest tube but nurses cannot except if employed in a flight nurse or ambulance role? Why is it that are profession seems to want us more educated but we have allowed ourselves to become "dumbed down"? So yes, the idea of paramedics taking over the ER nurse's role is a real threat, and it should not be taken lightly. Paramedics are great to have in the ER...but paramedics are paramedics and nurses are nurses. Embrace your skill set, and do not allow others to take anything more away from you! You went to school. You learned the skills. You know how to critically think! Nurses are more than just well educated technicians. I am more than a butt wiping, pill pushing, bed making technician. So are all of you. Keep this in mind as you move through your career. Nurses need to come together, not grow apart if this profession is ever going to be something more. Mark

Well said Nurse Brandie! Okay fellow professionals. Listen up, as what Brandie said makes a valid point. We must not give give up our career roles to other specialties. Any of you that do not believe this is an issue, please consider the following: 1. Anesthesia started out being administered by nurses, that's right, nurses...not physicians. Nursing gave this role up to physician anesthesiologists. Yes, we still have the CRNA profession, but now there is a new role out there called the Anesthesiologist Assistant (AA). It is a master's degree program that physicians created to keep the midlevel anesthesia providers under their thumbs. The position pays as well as, if not more than, a nurse anesthetist. 2. Physical Therapy and Occupational Therapy started off as subspecialties of nursing. Yes, PT's and OT's were orginally nurses that received specialty training in the activities of PT and OT. But we gave these positions away too and now the PT has become a clinical doctorate degree and the OT has become a master's degree. 3. Midwives originally birthed babies, not physicians. In fact, the first known male physician to witness a live birth dressed up as a woman to see the event, and when it was discovered, he was burned alive at the stake. Yes, we still have nurse midwifery, but it never should have been given to the male physician group. And also look at what CNM's get paid compared to OB/GYN physicians...for pretty much the same job. 4. RN's used to be able to mix drugs in piggybacks for I.V. administration. Now pharmacists have completely taken over that arena too. Why is this important? Well, just this...did you ever need a drug in an emergency situation, like Mannitol, but had to wait for a pharmacist to mix it and you get it back in 30 minutes when you could have mixed it in 5 minutes flat? Look around you...nursing's skill set is being taken away, but our nursing leaders are demanding us to have more education. Why? So yes, the idea of paramedics taking over the ER nurse's role is a real threat, and it should not be taken lightly. Paramedics are great to have in the ER...but paramedics are paramedics and nurses are nurses.

Whoa! Hold on now Medic 173. Medics replacing a physician assistant and a nurse practitioner? I think not. Almost all PA's and NP's have master"s degrees, are trained in advanced pharmacology, advanced anatomy and physiology, differential diagnosis, as well as many other upper level graduate courses. Last I checked, paramedics do not have a DEA number for prescriptive priveleges. As an RN, I would quit before taking an order from a paramedic. I have trained paramedic students in the ER I work in. They are responsible for only the drugs they carry in their drug boxes in the field. Thus, there are many medications used in an ER that a paramedic cannot legally administer, let alone prescribe. Furthermore, I have heard comments on this blog like: RN = 2 years and Paramedic = 2 years. I dispute the validity of this statement. Try 1 - 1 1/2 to 2 years of prerequisites depending upon whether the program is an ADN versus a BSN program. These prerequisites include anatomy & physiology, biology, psychology, sociology, lifespan developmental psychology, pathophysiology, chemistry, and much more. An ADN has 3 - 3 1/2 years of education in most ADN programs prior to graduation. Most BSN programs require 4 - 5 years. EMT Basics can get educated over the summer in Arizona (3 months) and qualify to take their state and national certifications. After a year of practice (not a year of formal continuing education), they can apply to a paramedic program. Out here in Arizona, a full time paramedic program takes 6 months, a 3/4 time program takes 9 months, and a part-time program takes 12 months. Thus actual time of formal education for paramedics in Arizona in the full time programs is 9 months. Now I realize paramedic training differs from state to state, but they all take the same national certification exam, and thus all have a fairly universal body of knowledge. Are paramedics useful in an ER? Yes. Do they have the same body of knowledge as an RN working in the ER? No. Should an RN and Paramedic be interchangeable? Absolutely not. The paramedic scope of practice is limited. They are not taught nearly in depth enough to understand why they do what they do to treat life threatening emergencies. Many paramedics I worked with who later became RN's have commented to me that they really never knew why the interventions they performed in the field worked until after becoming an RN. By the way, in nearly every ER I have worked in that utilizes paramedics ( and I have worked a few), paramedics are not allowed to intubate, put in chest tubes, do cut downs, insert central lines, etc. It's not that they aren't trained to do it, it is just that hospital policy says they cannot do it for liability/insurance reasons. Thus, it is left to the PA's and physicians to do it, not paramedics. Also, for the nurses that are attacking the other nurses opinion that paramedics should not be used in the ER...please just leave her alone. She has a right to her opinion. Just because she disagrees with yours does not make it wrong. I have worked with many ER nurses who feel the same way as her. I never reprimanded them even though I didn't agree. Paramedics are useful in an ER setting.

Hello all! I'm back with even more opinion than ever before. I am in a master's distance education program to become an FNP. I have barely started and I am going part time, which will take me 3 years. I already have professors urging me to go to Case Western Reserve University to get my DNP as soon as I finish. Why do I dislike this concept? Let's use our critical thinking skills shall we? The DNP degree is being devised to be the entry level degree into advanced practice nursing. The current programs for non-MSN degree holders is a 4 year program, NOT a 3 year program. The programs for the post-MSN DNP degree are 1 year in some cases and 2 years in most cases. So why balk? Who cares if there is only a one to two year difference? Well friends, consider the facts. It takes at least 4 - 5 years to get a BSN. You must then work at least a year as an RN for acceptance into most programs. Now you are looking at 4 more years to get the entry level DNP degree. That's nine to ten years people. Is it just me, or does this sound a whole lot like the medical school way of doing things, minus the specialized major NP's are required to have prior to enrolling? What does this investment get you? More respect by the medical community? No. Increase in scope of practice? No. Increase in pay? Yes, approximately $6500 more per year annually, according to the following website: http://nurse-practitioners.advanceweb.com/common/editorial/editorial.aspx?CC=65135 That's approximately $3.125 per hour more than a master's prepared NP, considering that the average NP works 40 hours per week x 52 weeks per year. Wow! $3.125 an hour is real incentive to go back to school for a doctoral degree. Now let's look at pay on a national level compared to other "doctoral" groups, shall we? According to the Advance for Nurse Practitioner's 2005 Salary Survey, the average NP earns $74,812 year. The median salary for a Pharm.D (Pharmacist) is $98,721 nationally (http://salary.monster.com). The median salary for an optometrist (O.D.) is $98,318 nationally(http://salary.monster.com). How about a dentist (DDS)? $120,695 nationally(http://salary.monster.com). The median salary for an Attorney I (that's a novice attorney with a J.D.) is $82,345 nationally. An attorney III (an expert attorney with a J.D.) makes a median salary of $142,976 nationally (http://salary.monster.com). Heck, an average P.A.-C earns $77,721 as a median salary annually (http://salary.monster.com)...once again more than an average NP! Why else could be wrong with this picture? Well, now we'll have 2 classes of NP's...those with doctoral degrees versus the MSN degree holders. Sound familiar? ADN v.s. BSN? Great! Another dividing line! How about decreasing NP school enrollment? Uh, let's see... 8 years of post secondary schooling for an MD or DO, add formal post degree residency (3 years), upon completion of 11 years: $130,000 + a year. 8-9 years of schooling for a DNP, plus one year of RN experience, no formal post degree residency, upon completion of 9 to 10 years: $60 - 70,000 a year. Anyone else see a problem? NP's will not serve as medical directors of hospitals (maybe clinics if they are lucky). NP's will not be able to do everything a physician does anytime soon. What is the point of the DNP degree again? Just a thought. Mark

Siri, I want to be an FNP but work in the ER. My background is in ICU/ER nursing. But where I live, PA's are the provider of choice in the ER's. Furthermore, the BON in my state sought to clarify the NP role further by stating NP's cannot work in specialty areas such as cardiology or emergency rooms without obtaining documented evidence from a school of higher education of didactic and clinical hours within that specialty in either his or her NP program or after graduation from an NP program. Being that none of the universities offer post master's training in cardiology, emergency, urology, etc, how can the FNP possibly demonstrate to the BON adequate training in the area he or she wishes to work? Furthermore, how does an FNP break into emergency medicine when emergency physician groups seem hostile to NP's? How did you do it? I really want to do emergency medicine, but I do not wish to become a PA. Any advice you could give me would be greatly appreciated.