I'm prepared to be flamed for this, but... no... just no. Time spent training is what makes people better, see Malcolm Gladwell's 10,000 hour rule. NPs are a valuable asset to the patient care team, but they cannot and should not replace physicians. IMHO, NP's wanting to be defacto doctors without going through the training diminishes the perception of nursing as a whole and cheapens what NP's bring to the table. Nursing is a school of thought and practice that at its heart is very different from the medical model. Respect nursing and allow it to be what it is, a valuable part of patient care, it's not less than medicine, it's different. Hence, there are different roles and different responsibilities. I'm pretty sure that the hospital where I work would flip a lid if a physician tried to give a patient a bed bath or change a patient's brief... that is out of their scope. Plus, I'm pretty sure they'd make a giant mess and as a tech, I'd have to clean it up... lol. You want to practice in the same way a doctor does without NP restrictions? Go to medical school. This crap is tantamount to a civilian pilot whining that he can't be a naval pilot and demanding that he be allowed to assume the role with his current level of expertise ... dude... you aren't trained to do all the stuff you need to do. You don't like it? Tough. Want to be a naval pilot? Go do the work, get the training. No, being a naval pilot isn't better than being a civilian pilot IT'S JUST DIFFERENT and additional training is required. I'm sure a naval pilot would also have to learn quite a few things in order to become a civilian pilot. Also, your argument that a surgeon's rotation through ICU as a resident would not impact their ability to be a better practitioner is ludicrous. Where do you think surgical patients go after surgery? Quite often, it is the SICU. Knowing where your patient is going and having seen the consequences of different decisions that were made by the surgeon is a powerful learning opportunity for a budding surgeon. Here's just a few examples of things a surgery resident would learn in an ICU rotation: "GY I/II - Surgical Intensive Care Unit Service A. Medical Knowledge The resident should learn in depth the fundamentals of basic science as they apply to patients in the intensive care unit. Examples include anatomy, physiology and patholophysiology of the cardiovascular, respiratory, genitourinary, gastrointestinal, musculoskeletal, hematologic, endocrine systems, respiratory failure, coronary ischemia, shock, malnutrition, stress ulceration, nonocclusive intestinal ischemia, antibiotic-associated colitis, antibiotic resistance, jaundice, and renal insufficiency. The resident should understand the rationale for admission and discharge criteria in the ICU. The resident should understand factors associated with assessment of preoperative surgical risk. Examples include evaluation of the high risk cardiac patient undergoing non-cardiac surgery. The resident should understand fluid compositions and the effect of the losses of such fluids as gastric, pancreatic and biliary fistulas at various levels. The resident should understand the indications for, and complications of blood component therapy. The resident should be able to discuss the pathophysiology of respiratory failure. The resident should be able to demonstrate an understanding of acid-base disorders, including diagnosis, etiology, and instituting appropriate treatment. The resident should be able to discuss the pathophysiology, indications, and complications associated with various modes of mechanical ventilation. Examples include ventilator management of ALI, ARDS and thoracic trauma, as well as weaning from ventilatory support. The resident should understand the role of hormones and cytokines in the graded metabolic response to injury, surgery and infection. The resident should understand the indications, routes and complications of administration of parenteral and enteral forms of nutrition. The resident should understand the factors associated with altered mental status. Examples include traumatic, septic, metabolic and pharmacologic causes. The resident should understand the risk factors associated with stress gastritis. The resident should understand the causes and treatment regimens for gastrointestinal bleeding. Examples include bleeding from upper and lower GI sources. The resident should understand the factors associated with bleeding disorders. Examples include DIC, ITP, hemophilia, coagulopathy associated with shock and hypothermia. The resident should understand the pathophysiology of hemodynamic instability. Examples include types of shock, cardiac arrest. The resident should know and apply treatments for arrhythmias, congestive heart failure, acute ischemia and pulmonary edema. The resident should understand adjuncts to the analysis of respiratory mechanics and gas exchange. Examples include work of breathing, rapid shallow breathing index, CO2 analysis and dead space measurements. The resident should understand fluid and electrolyte as well as acid/base abnormalities associated with complex surgical procedures and complications. Examples include massive fluid shifts associated with trauma, shock and resuscitation, high output fistulas and renal failure. The resident should understand the pathophysiology associated with endocrine emergencies in the ICU. Examples include thyroid storm, hyper, hypoparathyroid states and adrenal insufficiency. The resident should understand the risk factors and common pathogens that are associated with nosocomial infections. The resident should be able to discuss the mechanism of action as well as the spectrum of antimicrobial activity of the different antibiotic classes. Examples include carbapenams, extended spectrum penicillins and fluoroquinolones. The resident should understand the risk factors that result in multiply resistant organisms. Examples include antibiotic dosing, antibiotic synergy and transmission patterns. The resident should be able to discuss the factors that result in an immunocompromised state. Examples include malignancy, major trauma and steroids. The resident should understand the pathophysiology of traumatic brain injury and neural disease. Examples include knowledge of intracranial pressure monitoring and maneuvers to normalize ICP. The resident should be able to discuss the pathophysiology, presentation, and causes of hepatic failure. The resident should be able to discuss the pathophysiology, presentation, and causes of renal failure and indications for intermittent dialysis or continuous hemofiltration. Examples include pre-renal failure, acute tubular necrosis, hepatorenal syndrome. The resident should be able to discuss end of life ethical issues. Examples include organ donation and withdrawal of support." SICU Resident Orientation - Training & Education - Trauma, Critical Care, and Burns - Division of Surgery, UCSD #dealwithit #sorryi'mnotsorry