menetopali

Advise charge, call RR and/or send pt back to ED if the pt is deteriorating and provider is non-responsive. Remember that the nurse's primary obligation is to the patient, not anyone else.in this case the provider may not have responded for any number of reasons but they are the ones responsible for ensuring coverage and therefore they should be reprimanded through the medical staff oversight process. If you are getting grief from nursing admin for advocating for your patient then you may consider looking at another place to work.

Never trust a computer you can't throw out the window.... Wozniak

I am an FNP and DoN for the hospital I work in, I know that a hospital CEO in the valley is also an RN so there are definitely options out there

Strongly recommend you seek a place to practice elsewhere. If policy says x and practice does y then you are in a very bad position should there be a negative outcome, audit, or legal action taken. Get out now.

My immediate supervisor is the CEO and not an MD. I am in an interesting position in that I am the DoN and an FNP. With the FNP hat I am , I join the outpatient psych medical director and inpatient psych medical director as the primary care director as an equal member of the medical staff executive committee. As the inpatient DoN I report to the CEO and join the Inpatient director of social work and inpatient medical director as an equal member of he hospital executive committee. I would not be concerned about reporting to a non-clinician for administrative issues (most CEO's are not clinicians after all) but as an APRN I would expect that you are treated as a member of the medical staff or the APRN staff with equal standing to the other providers.

I'm done with the troll. As is common with trolls - no cogent argument is presented, no evidence supplied, no counter-point to any argument raised. The troll merely acts to raise emotional tension.

the DNP is a doctor. i will say that claiming a professional credential (physician) that one does not posses is unprofessional and i find it hard to believe that the DNP actually said that. As i noted before, med school isn't an exclusive club for mensa members and frankly find it a it patronizing that you believe DNPs just couldn't get into to med school.

i'll answer with a bit less vitriol than was originally posted - first, if i wanted to go to med school and be a physician, that's what i would have done. i am in fact a nurse and very proud of that fact. second, i find it a bit insulting and degrading to claim that completing medical school demonstrates some level of intelligence above those who complete another doctoral program. After all approximately half of med school applicants are accepted to a U.S. med school and 98% of those who start, graduate [Wake Forest, 2003] - not exactly a club reserved for mensa members. third, i practice nursing - not medicine - and that means that instead of treating a lab test, a radiology study, or a collection of symptoms, i treat patients - and do so under my own license, my own DEA#, and my own NPI# without paying a kick-back to somebody who never went to nursing school. is a DNP a doctor? - yes. is a DNP a physician? no. is a psychologist a doctor? - yes. is a psychologist a physician? - no. is a physician a doctor? - yes. is a physician a nurse practitioner? no. they training is different, the approach is different, the emphasis is different - not better or worse but definitely different. fourth, i treat the entire patient - not just neck-to-waist ("mid-level") fifth, NPs in primary care provide care with equal outcomes, fewer prescriptions, and better patient satisfaction than MDs or DOs - [Cochrane Review, 2007], hardly "endangering patients". To date I have seen no study that empirically supports the opinion of those with clear economic interest in preventing competition from other provider types - a point that was made almost thirty years ago in a congressional report of delivery of primary care and several other health policy organizations have come to the same conclusion. On top of all of this, even the American College of Physicians acknowledges the high quality of NP care. last, but not least - if one wishes to be a floor nurse, that is a noble and important thing to do, but to claim upset when others choose to move on to other pursuits is bit childish - surely you have no issue when a nurse specializes in emergency nursing or critical care while another nurse goes into education or administration or public health? why the animosity when a nurse moves into the specialty of providing primary care as a doctoral prepared nurse?

short answer is that attending a program that is not accredited by a recognized agency is a risk that you must weigh. most schools have several accrediting bodies - one for the college or university itself, another for the college within the university, and another for the program within the college. if the program isn't accredited but is applying for it or is 'provisional' and the college/university are accredited then it's probably a low risk gamble. on the other hand if the college/university isn't regionally accredited then i would avoid them as there is a real risk that the education you receive will not be recognized by other institutions of higher education or industry.

ASU has a hybrid program, UofA has a program with local clinicals and two weeks every year, UofP has a hybrid program.

BSN was a cakewalk as it was mostly a rehash of the ADN with a couple of extras - half the MSN was that way as well (ie "nursing theory", research, ethics). The tough part of the MSN was the patho, pharm, and clinicals. I worked full time through the BSN and it was almost a hobby. For the MSN it was busting hump every day while working a Baylor in the ED (it was a great choice for an FNP student - much better experience than the ICU to see primary care stuff). hope this helps.

Arizona is like that - you can check the Pearson report at: http://www.webnp.net/ajnp08.html for a comparison of practice environments from state to state.

The University of Arizona has an interdisciplinary (physicians, nurse practitioners, and physician's assistants) fellowship in integrative medicine directed by Dr Weil

maybe in any state law - but federal law, specifically the social security act (and medicare by extension), defines "physician" a bit more broadly to include dentists, podiatrists, chiropractors, and optometrists - 42 U.S.C. 1395 1861® to the OP - an NP is not a physician and a physician is not an NP. the patient may have used the colloquial 'physician' to refer to their provider, it is unlikely that either they were mistaking the professions as the patient clearly identified the NP, I think it is also unlikely that the patient was 'humoring' the NP. this helps demonstrate two things - (1) acceptance of the NP as PCP in the public eye and (2) the need to continue to educate the public about the NP profession and that while an NP may be their 'doctor', an NP is not a physician and a while a physician may be their 'practitioner', physicians are not Nurse Practitioners.

sure, i'll participate.

i'm not insunuating as much as saying outright that DNPs (and frankly all new NPs) should be able to participate in federally funded and closely mentorred experiences after graduation and before flying solo so to speak.

my program has computer log system that tracks this info - what isn't included includes orientation, drive time, meetings, lectures, condition/disease discussions, etc. in a given 8 hour day (excluding lunch), i may only log 5-7 hours of patient time with the rest as chart reviews, f/u letters, review of labs, care coordination between office & hospital, or the myriad of others things included in providing care in a family practice. in contrast when we have medical students float through they count every minute from when they set-foot in the building until they leave for the day. (ie - my 5 hours equals their 9).

It is this very steep learning cutrve that physicians are helped through via residencies. unfortunately those with an economic agenda, instead of a patient agenda, block the inclusion of DNPs in residency programs (even though there are many empty slots) and cry "poor" when nursing seeks funding for NP residency programs.

This is a poor comparison as noted, no one is eligible to sit for the NCLEX if they did not attend nursing school. A similar pattern is a point of critisism of the current medical license exams (USMLE & COMPLEX) that has been raised by NPs.

that's interesting because my clinical time only counts actual patient care time. If a patient no shows, i can't count that time, can't count lunch, can't count drive time from site-to-site. the result is 1000 hours total of patient care time in family practice (and i don't think that is enough - as i have noted here and elsewhere) unlike the "clock-time" some professions use where sleeping, eating, meetings, and lectures are all counted in the "15,000" hours that are claimed for which they are paid.

I think one of the reasons we are in this position is the "turf war" that continues. the arguement that procedure X (IV start / suturing) can only be done by profession Y (nursing / medicine) has lead to the problem of "that is pacticing Y without a license". the reality is that there is overlap between professions and we all need to recognize that fact. the auto mechanic example is a poor one as there is little (if any) overlap and i would be shocked if either the professional organization of auto mechanics or legislature would include appendectomy as part of their scope of practice (let me know if you find one). the paramedic example is an excellent one - in that example, nurses are claiming the same "turf encroachment" that nurses accuse medicine of claiming. in that case i would argue that a paramedic practicing within the scope outlined by that state is just as capable of performing in a hospital as they are in the back of a rig (placing IVs, administering meds that they are authorized to administer within that state, etc) and should be held to the same standard as anyone else in that role (ie ED nurse) while they would be practicing their profession under whoever authorized their authority to practice in the first place (department of health services i think - but sombody can correct me on that one).

surely you aren't saying that a physician who starts an IV is practing nursing? or are you saying sedation provided by a dentist is medicine? or a nurse who does diabetic foot checks is practicing podiatry? the practice of a profession is determined by the profession. while professions may have overlapping functions and may share standards of care (ie the same standard of care for sedation applies whether it is the practice of dentistry, medicine, or nursing) - the "practice of..." has been determined by the courts to mean those things that are performed by members of that profession. the practice of nursing, practice of medicine, practice of dentistry, practice of podiatry, practice of psychology, et al, all include acts of diagnosis and treatment defined by each of those professions. an NP who diagnoses major depressive disorder is practining nursing, a physician who does it is practicing medicine, and a psychologist who does it is practicing psychology - all use the same diagnostic criteria, same diagnosis & billing codes, etc....

newsflash: nurses have been providing primary care to the poor and undeserved for almost a century - it is only when they become an economic threat that medicine gets its ire up. as long as nurses only care for those who can't line medicine's pockets the Board of Medicine doesn't care. Just as an FYI: nurses have successfully fought claims of "practicing medicine without a license" for at least 28 years and have been held to the same standard of care for 24 years with the associated liability. NPs have been providing care comparable to primary care physicians for at least 45 years, CNM have provided Ob care with outcome comparable to and frequently better than physician counterparts for 80 years or more, CRNAs have been providing safe anesthesia for more than a century (and yes the first physician anesthetists a.k.a. anesthesiologists went to nursing school to learn how to do it). now as to the crack about "managed to practice medicine under the guise of nursing" - i hate to point it out but we are practicing nursing, not medicine. for example - if a nurse puts an IV in, it is nursing while a physician doing it is practicing medicine; if a dentist provides sedation - it is dentistry, if a physician does it - it is medicine, and if a CRNA does it - it is nursing. as for the push for independence, NPs are already independent in 11 states - as in there is no requirement for physician involvement in care; zero, zip, nada. as for taking on a "complex case" - guess what, cases are 'complex' based on the experience of the person treating the patient (not the "case") - insulin resistant patients that are 'complex' to the family physician may not be very complex to the nurse practitioner who is experienced in diabetes management. Just as i wouldn't go to an NP for heart surgery, I wouldn't go anywhere near a CV surgeon for primary care. last but certainly not least, the claim "you don't know what you don't know" is oft repeated as if medicine is immune to the same logic. physician led care has failed the American people over and over because they don't know what they don't know. physicians are not taught basic care coordination, teamwork, interpersonal communication, inter-disciplinary care, or even to realize what other professions know or don't know. do physicians learn to speak with pharmacists about multiple medication management (after all the pharmacist has a lot more knowledge about a much wider range of drugs than the physician) or to consult a diabetic nurse educator before jumping straight to drug therapy (after all that is what these nurses do all the time and the physician may only do occasionally)? while physicians often claim otherwise (without evidence I might add) that they know best - the reality is that they do not know everything about health care or frequently even know that there are people who know more about certain things than they do. everyone has the "you don't know what you don't know" problem - the solution is to break out of the silos and see what other people in health care do well and what they don't do well. for example if i want a surgical solution - see a surgeon, lifestyle change - see a nurse, through drugs at it - see a physician, talk it through - see a psychologist, manage a patient among specialties - see a care manager. primary care can be, and has been, provided by nurse practitioners for decades over the objections of the AMA who have always claimed "quality concerns" with no evidence in 40 years to back the claim and notation by health policy groups (including the federal government) that the objections to NP independence by physician groups are directly tied to the economic interests of those groups as no evidence exists that care provided by NPs is substandard.

no argument that more clinical training for the NP would be a good thing - perhaps in a system that provided exposure to a wide variety of cases under the eye of a mentor in the field while being shielded from a significant amount of liability and while receiving a stipend from the taxpayer immediately following completion of school. perhaps you will join me in support of a funded NP residency system (before the anti-nursing bunch cries poor)?