bajasauce07

The drugs we use currently target reverse transcriptase.

Well, Golden Girl. I agree with everything you said, You'll have to read the previous posts and take in context my above sentence. It often asserted that patient "happiness" is a measure of practitioner quality. They aren't related. At all. They should be, but many patients love their doctor in spite of incorrect care/ diagnosis, etc. That's all. And many patients think their specialist who saved their lives is a stupid jerk and switch. You won't keep patients without bedside manner, and you will miss out on important history if they aren't comfortable with you. but again. Quality is more dependent on knowledge than rapport.

quite agreed. How are PA and NP schools different?

Wait, so PA school is far more intense, but the training is less?

Really? All the nursing associations are gathering the data? And it's all awesome? I had no idea! Studies on noninferiority when dealing with proteinuria are excellent. But lets have a study on how many of these protenuria patients were actually patients with various hypergabbaglobulinemias or vasculities, or HIV nephropathies. Did the NP group recognize the early presentation of Multiple myeloma? or Multiple Gammopathy of Unkown Significance? or Waldenstoms macroglobulimemia? Or did they just put those patients on an ACE-I and remeasure a few months later? If you didn't know those disorders existed that would be the route to take. This would lead to delayed diagnosis, and treatment and early death/morbidity. As far as getting sued? the patient would have no idea that the diagnosis could have been made earlier. No one would sue. Patients see a provider based on how nice they are, not how skillfull, and you know it. To CURIOUS ME: I know you are all taught the basics of pharmacology. And you should make sure to remember those things as you graduate and continue to practice. The thing is you don't REALLY need to know the pharmacology to be a mediocre nurse. Just take the orders of the chart and do what the doctor says and you'll keep your job. A good nurse would keep up with his/her pharm and be able to recognize and point out potential mistakes in therapy. Go ahead and ask a nurse with 5 years of hospital experience what any drug does, you'll be surprised how many have let their skills slip. My point when I said that was simply that nursing school should not be used as an excuse for a less intense practitioner training, it doesn't provide much in the way of preparation. All of an NP's medical training will occur in NP school. Prior nursing experience does not prepare to be a practitioner of medicine.

and I'm not a nurse. I'm a PA

On what do these agencies make these recommendations? Either way, we shall see.

Look, sorry that my posts seem so inflammatory, I apologize for that. If you'll read the post previous to the one where I talk about nursing education it is in reply to the idea that NP's are "better" than PA's because of the nursing education they receive. It is also the basis for the argument as to why NP school can be done part time and with 600-1000 clinical hours of training which then allows one to practice independently. And yes, the problem is you could come up with a basic differential for a cough. I'm not arguing that. You just couldn't come up with a COMPLEX differential for a cough. My argument is not that nurses are dumb. My argument is that they are not trained to practice medicine and this training should not be used as a way to call yourself "better" or ready to practice solo after only a little more training. My argument is that "medical" training occurs in NP school and it has nothing to do with your previous education. I hope that seems less inflammatory, I think it comes across that way because I try to use too many examples and it makes me seem like I'm trying to be a know it all. I'm only trying to use the examples as evidence of my point. I DON'T know everything. I am very familiar with nursing curriculum however because I help tutor some nursing student friends of mine about once a week. We talk through the info they need to know. I know what they are expected to learn. Again, they are trained very well to be nurses, I don't think anyone can argue that they are not being trained to be practitioners though? Like I implied, there are EXCELLENT, AMAZING nurses that I've personally seen and met who definitely need to keep going to NP or PA or med school if they desire it, but they are not ready to be practitioners of medicine without that training. Nursing is the same as any field, most people are happy only knowing what they NEED to know in order to do their jobs. Same with NP's, PA's, and MD's. Thing is a lazy nurse knows only basic principles, a lazy midlevel knows enough to handle common, everyday things and a lazy doc know's more by virtue of all the mindnumbing, years of training than all of the above. Even by accident the laziest doc will know quite a bit. So if we know anything about human nature we know that there is a danger to credentialing people with less training than an MD to practice independently, not because of the good Midlevels, but because of the many lazy ones that would be out there hurting people without even realizing it sometimes. Even if that is not he majority. An excellent nurse who keeps up to date on her patho, pharmo, and reads about the underlying diseases of their patients could get CLOSE to knowing what their NP or PA counterparts know, an EXCELLENT NP or PA could get close to, and sometimes surpass the lower rungs of MD's on the same scale due to the virtue of their training etc. but a good PA/NP will NEVER outshine a good doc? So I don't understand this line of reasoning that we all use. "Well, if a good PA or NP can do better than a bad doctor, why can't they be independent?" I have an idealistic view of everything, especially medicine. I feel like we have a responsibility to our patients and to the respect of our professions by those who observe us to be THE BEST. If you want to be the best, and offer your patients the best as an independent practitioner, be a good doc, don't take a shortcut way which could lead to a bad outcome by simply failing to recognize something? We have our place, and we can manage very complex and rare cases. But it should not be as independent practitioners. As far as the question of whether or not nursing experience provides an advantage over a "22 y/o with a B.S.?" Not really, at least not once you get past the first week of PA school which is the only week in which normal laboratory values and medical terminology are covered. After that its all new material for nurses AND the 22 y/o. same with NP school I'm sure.

Medicine has EVERYTHING to do with how knowledgeable you are and NOTHING to do with how nice you are. It's just good to be nice as well. As far as the comment above about NP vs PA? You can come out of training as either an NP, PA, or MD and be a moron. It's all up to the individual. I have not touted PA's as masters of diagnosis, I do think the training is different and I prefer the methods of the PA way, but my argument has been, and will likely always be, that midlevels should not practice independently. Of course, as someone pointed out, NP's do practice "independently," depending on how you define that. But it's irresponsible. We all have a place in healthcare, but if you want to be the boss, be the MD. You don't learn construction and then try to practice as an engineer.

Oh, and I don't think there are ANY NP's in "solo" practice anywhere. Hospital bylaws do not allow it.

Sesquatch: Calling out sepsis is not a diagnosis. Learning the difference between the manifestations of sepsis and addisonian crisis, or myxedema coma is diagnosis. Understanding the significance of proteinuria which could be anything from multiple myeloma, CKD, MGUS, amyloidosis, HIV nephropathy, or a billion other things or nephrotic syndromes, is diagnosis. Half of those things aren't mentioned at all in your nursing curriculum. Recognizing patters to be able to complete a diagnostic workup for MM, MGUS, waldenstom's macroglobulinemia, cryoglobulinemia etc. THAT is diagnosis. MOST nurses ARE drones. And its sad. and YOU know it. Don't get me wrong. a nurse who understands why he/she is giving X medicine is gold, or why the doctor is ordering X test is invaluable. It leads to better patient care. The sad thing is that most nurses have no idea. I've worked at multiple major and rural medical hospitals and many nurses choose to let any pathophys, or pharmacology they did know slip in favor of mindlessly carrying out the orders. Again, not saying this is ALL nurses. I've met a couple of nurses who I think would make excellent NP's PA's etc and their talents and knowledge are an excellent BASIS for further education. Maybe you are one? But DIAGNOSIS is not taught in nursing school. You go to NP/PA school for that. Unless of course you can honestly tell me you recognize those disorders from your original nursing training? ChiroMed: You cannot "fight the fire" without having the knowledge to spot it. Delivering a baby does not equate to coming up with a differential for belly pain. That is literally a list of at least a thousand differentials including autoimmune, infectious, malignant, genetic, and multiple unnamable others. It is not just "constipation" and "pregnancy."\ Understanding patients is nice, but also has NOTHING to do with managing care and is far less important. That's like me saying knowing the proper alignment of the spine is nice, but as long as you UNDERSTAND patients anyone can be a chiropractor, it's ludicrous. I would be willing to bet you have not taken all the same courses as an MD. I know you take some of the pathophys, biochem, etc. I doubt that it matches up. (I can't say for sure since I've never bothered to look into that curriculum, but I will ask a good Chiropractic friend of mine currently in 3rd year Chiro school, I may be wrong.) Either way, I've never said that those courses are what makes an MD an MD, neither will you find an MD who says that. Everyone freely admits that you forget those things after STEP 2. What makes an MD an MD is the years of practice in diagnosis. Once you have a diagnosis treatment involves looking it up with occasional patient specific variations. If you are never taught all the differentials you can't even smell the smoke. Yes NP's and PA's can treat patients obviously, My point was only that the previous experience nurses carry to the table means nothing. All of the "medical" training happens in NP or PA school. nothing more was implied.

Problem is nursing has nothing to do with medicine. At least not in the sense of treating and diagnosing, which is what you are supposed to be doing as an NP or PA. Also, PA's are taught treatment, I'm not sure how you separate diagnosis/rx from treatment/management? they're the same thing. Plain and simple nursing school will help you treat and diagnose patients about as well as a technical college electrician can claim that his training allows him to work on the space shuttle. I will concede that you, as a nurse, will be more familiar with terminology perhaps once you start, and some of the medicines. But that is all. Don't be confused, your "medical" training is 100% in NP or PA school as a midlevel. PA's who began as nurses have no advantage over what I just mentioned compared to PA's with no medical experience prior to PA school (most of whom do anyway). Are you in nursing school right now? can you honestly say that anything you are learning would help you come up with a decent differential diagnosis for even a cough? or belly pain?

MBREAZ I call strawman on my post, The provider in my example was not lying, I said his actions were not malicious, perhaps he did not know, or he forgot for that patient to start appropriate therapy, Either way, you prove my point you admitted that the patient would have no Idea if the provider was lying, still be happy with the care/provider and continue about his way. I believe with your admission that I am right I am done with this thread. It's like banging my head against a brick wall, only without any of the pleasure of the exercise. I bid you all adieu.

MBREAZ, you still haven't offered a rebuttal to this post of mine, I would really like to hear your thoughts: not true. definitely not true. I don't get how you believe that. If you are nice to a diabetic patient who has protenuria on his dipstick, and you never put him on an ACE-I or ARB. A few years later he enters into renal failure that could have been prevented. As long as you are nice to the guy he'll never know the difference and be completely satisfied with you as a provider. After all, I'm sure if this happened it wouldn't be malicious, it would simply be that the provider didn't know, he would explain to the patient that renal failure is a natural part of the life of many diabetics and both would continue on their way. Seriously, the scenarios are endless. Patients do not know about a lot of what we do. How in the world do you compare a happy patient to a healthy patient? they don't equate. Apples to tigers. It's not even in the ballpark. I've run across the same thing in practice, the PCP doesn't have the patient on x medicine that is necessary according to current guidelines and I have to start it in the hospital. The patient still loves their PCP even though the PCP missed something. The patient just didn't know! And WOWZA, as far as this :"Lowering your standards for accredidation or for rigor of education endangers people' lives. " Let the buyer beware right? who cares?

antiquated notions like education?

I would like to know what hospital this is in.

not true. definitely not true. I don't get how you believe that. If you are nice to a diabetic patient who has protenuria on his dipstick, and you never put him on an ACE-I or ARB. A few years later he enters into renal failure that could have been prevented. As long as you are nice to the guy he'll never know the difference and be completely satisfied with you as a provider. After all, I'm sure if this happened it wouldn't be malicious, it would simply be that the provider didn't know, he would explain to the patient that renal failure is a natural part of the life of many diabetics and both would continue on their way. Seriously, the scenarios are endless. Patients do not know about a lot of what we do. How in the world do you compare a happy patient to a healthy patient? they don't equate. Apples to tigers. It's not even in the ballpark. I've run across the same thing in practice, the PCP doesn't have the patient on x medicine that is necessary according to current guidelines and I have to start it in the hospital. The patient still loves their PCP even though the PCP missed something. The patient just didn't know!s:uhoh3:

Sorry, I think I misread your post. By "practicing solo" I mean operating independently of a physician. As in they are admitting/rounding on their own patients, or working in an ICU without an MD cosigning orders. Basically that they don't have any contact with an MD except consults. I think in outpatients NP's do have independent clinics, as in no MD's cosigning charts?

um, you could answer the question, do you have any idea. I'm asking cuz I want to know, please dispense with the 'tude dude. thanks.

yeah, it's happening, but I don't understand, what do you mean by solo? All the hospitals I've worked in have bylaws requiring physician oversight? They have no MD's around?

oh, and quickly, to clarify, when I admit that there are some PA's pushing the same independence agenda as NP's I'm assuming you're right based on statistics and the fact that our profession toyed with the idea of a doctoral degree. I've never actually heard a single PA want independence nor is it the position of the AAPA.

um, quick thing, PA school and NP school never cross paths, as one poster mentioned, the other thing is that you should be careful with this "NP's have their own license thing" you will never see a hospital based NP working solo, always under supervision, second it's a rare thing to see them solo in the real world. Legislation does seem to be moving in that direction though, so good luck with whatever you decide. and PA's have prescriptive authority in all 50 states.

Whoah, I missed that the first go around... PA training is inferior? What do you use to claim that? I think you ought to check your curriculum against ours. Now I'll admit, we don't have all those fancy patient satisfaction courses and communications classes and we also don't have 4 years of experience opening tylenol bottles and giving suppositories, but I think we more than make up for that with our extra training in pathology, pharmacology, differential diagnosis, and clinical work measured by thousands not hundreds. Now don't get me wrong, there are plenty of "adequate" (your words, not mine) NP's, but you've thrown down a gauntlet here. I've reviewed NP curriculum and PA curriculum as well as have chatted with plenty of NP's regarding their training. It doesn't compare. Be prepared to back this up. As far as PA's not being for independent practice, you're right there are probably a few out there who don't have much common sense but the majority of those go back to med school. I hate to break it to you but yes, if NP's get independence I'm worried it would make it easier for these other PA's to whom you refer to push that through. We are not trained for that. You seem to think that primary care is just physicals, colds and diarrhea's where, in reality, they are the patients first line of detection and defense against ALL disease, not just the easy stuff. do you know what Churg-Strauss syndrome is, or whipples disease, or of the many different types of ILD? Or maybe the different dermatomyositis syndromes? Or the differences between Multiple myeloma, MGUS, Waldenstroms Macroglobulinemia? perhaps even something as simple as culture negative endocarditis. Perhaps typical histories of patients with histoplasmosis, tularemia, Q-fever, Brucellosis, schistosomiasis, naegleria, the natural vectors of leprosy in the united states, perhaps the geographic distributions of blastomycosis? Perhaps you know what organisms to worry about when someone who is iron overloaded (hemochromatosis/thalassemia) gets an infection after a trip to a salt water beach? I highly doubt it, neither would many of your nursing bretheren/sisters. I bring these up because they are but a few on a long list of diseases which can present insidiously, masquerade as the "Horses" and require a knowledge of, and high index of suspicion when seeing a patient complaining of a "small rash" or a "little" shortness of breath, or trouble combing their hair/shampooing etc. The point is, if you don't know they EXIST, how will you know to test or even refer? Time to diagnosis with these things equates directly to functional lifespan. You say physician training is excessive because you have NO IDEA how much medicine is out there. The very edges of the chasm that is the knowledge necessary to even be a good midlevel escapes your feeble imagination. Your next argument will be that these disorders don't matter because they are rare (some not as much as you are guessing), so you are willing to throw these under the bus? each of those statistics represents a real person, with a FAMILY, (and with a lawyer if they're smart enough to recognize they need it.) Next you'll say, oh doctors miss those too, yeah, but ask any of them if they're familiar with the disease. Even if they miss it the answer is yes. It was taught to them at some point, therefore if they miss these with their vastly more extensive fund of experience and knowledge, what makes you think you'll ever even get a shiver up your spine as you prescribe advil for the joint pains of whipples, or reassure the late middle aged woman that her trouble with her hair is due to age? or allow the nice old man with the "viral fever" who was out rabbit hunting last week or working with his cows to treat his fever OTC? Perhaps the rash from the child with the new pet armadillo in new mexico is atopic? as is the middle aged man's new onset asthma and slightly elevated eosinophil count (only slight, no cause for concern), or the young man who was diving in fresh water with the headache? The older african american man's proteinuria is surely due to his diabetes, nevermind his mildly elevated calcium or alk phos levels. oh what's that the alk phos is nothing because his gallbladder checked out? what a relief... The only reason this argument is allowed by politicians and NP's and YES PA's, is that they are IGNORANT of all that lies out there. The training is insufficient to allow independence. You continually point to satisfaction as a measure of outcome because in your limited breadth of knowledge, all disease is easy to treat, and therefore the only difference between you and the MD will be how "satisfied" the patient feels with your cheaper and "adequate" care. Don't worry though, it's coming, and then we will see. Though the outcome may be different than we all expect, especially a few years down the line. (Rainbows and unicorns don't work on these disorders sir or madame) and if the consumer is as astute as you think, they won't be satisfied with subpar care or late referrals. P.S. :and if my inpatient experience of internal medicine has no relevance here, perhaps you'd care to explain who you are? I'm starting to get the feeling based on the sound logic of your arguments that you may not even be a provider of ANY sort, and if so, again, I'm worried. also, are there 2 people on that username? you throw around the term idiot rather freely for someone who got on my case when using retarded as a description of a thing, much less a person...

But WOWZA, if the patient is happy, doesn't that mean I did a good job!??? I don't understand.... You're saying that if I do something wrong, and the patient is happy, I'm still wrong? Are you sure? all my communication classes didn't prepare me to accept this, you must be wrong.... sorry, couldn't resist.

Ah, so you've discovered the plot have you? No sir, my profession nearly followed in the same foolish footsteps with the whole doctoral degree. Luckily wiser heads prevailed and it has not become mainstream as of yet. No, my profession seems to closely follow yours just to keep up with the joneses if for nothing else. I actually would stand to gain from the situation even if not immediately so. I neither want or desire independency, only autonomy under a physician. I simply am of the opinion that so many of your own colleagues share. Don't let your hubris harm your profession or your patients. as far as this statement: "So what you are saying is that you can do a terrible job and still deliver good service? I don't think so. You can't separate the two in any business. If you didn't satisfy the customer, you didn't do your job. You just made the most ludicrous statement I have ever heard in my life. You might want to think about things before you post so that you don't sounds like a complete idiot next time." You're right, one of us does sound that way.... The problem is that I can guarantee I know more than you. hands down, a medical knowledge bowl etc. And even then I don't foolishly think I could do it on my own. That's not what my degree is for, neither is yours. you want to play doctor? BECOME ONE