clamchow

Thanks for all the great responses, I do have a good set of basic knowledge and believe I can approach the situation well now. I will try to do my part on help mentor the new nurse practitioners that we get in the ER during shifts. As I said before most of them are great, great people and I hated to ask such a pseudo condescending type question. We are all human and here to achieve the same goal, hopefully we can all find a way to provide great patient care in a safe, effective manner. Strong work to those who are able to be such great providers with such a short stent of education, I myself would probably not have faired so well being thrown out on my own after 700 or so hours of clinical experience.

I do apologize it my post came off as sounding as I believe that nurse practitioners are incapable. I think I stated in my posts that I did not believe that to be the case. My purpose was to state an observation (which a single observation, or even a few from one person has significant sampling bias so take what I say as a grain of salt), but much of what I restated in my third post was an integration of what many of the other posters have stated. I feel as I may have tread on your toes, which I am not sure how, but I do apologize if that was inferred from previous posts. We do specialize, and we do not come out of medical school knowing everything. An example would be a farmer who has tended his field to all crops, is able to grow all crops in his field, but his field is not able to be excellent or practical at growing a specific crop, and thus is not economical for baseline use. Freshly minted docs prior to residency are as that, just minted fields ready to become accustomed to growing one crop to the best of his or her ability. The crop would be the product of a finished resident (the resident's work), the early field as of a newly graduated MD/DO, and the finished field as a resident who has completed residency. The farmer could be considered a conglomerate of those who have trained the doc/resident/etc. The argument that nurse practitioners must specialize in Er does not quite answer the question since most NPs are placed in the fast track which has very little difference from a family practice clinic and even less of a difference from an urgent care clinic. I do remember performing lab evaluations, sutures, and the like during primary care rotations in both school and residency. Again though, I am not here to bash nurse practitioners, as I did state before they are a very important part of the team and do not doubt their intellectual capability. I feel as you may be looking for reasons to be offended though, which is unfortunate.

I am quite unsure of the context on a few of the responses, mostly by yhthr. The context of his/her posts seems rather difficult to follow and am I not sure of the point he/she is trying to provide. I do not really get involved much in the NP/PA/MD/DO etc debate. I do not feel we will lose any or much ground if that is what many of my counterparts are worried about. But back on topic, it does seem that many of the nurse practitioner programs do not offer a few of the rudimentary skills that psychguy describes. This probably does vary greatly, but it does answer my question. At least now I will know what to expect and will be wary on many new graduate nurse practitioners and attempt to give them the guidance they may need when they are pulling shifts in the ER. As others agree with, the problem of overconfidence does spam all professions, and I think I stated that earlier on to show my impartiality toward the topic. As previously stated there are great providers out there of all sort, but when it comes down to pulling teeth, it is very difficult to be prepared for any provider role in 700 hours or so. I also do agree that much nursing experience prior to does help. Often times the ER nurses at the facilities already have everything done before one of us provider type enter the room. And many of them are almost always correct on what to do and many could probably run the ER if needed. I know most people also know that there are many doctors that are rather not excellent” in a way to put it and often not motivated. This is very true, but the major difference is to be able to make it through medical school and residency without sinking into a subpar depressive state, is one must enjoy what he/she is doing. By forcing us through the tens of thousands of hours of residency, they are able to pound the needed information so thoroughly into our brains that even the least motivated physician will have the needed background to perform decently. The lack of motivation would provider a larger detriment toward the pa or np who has not been forced through this ringer quite as long and where each hour must be cherished to maximize knowledge gained. The self-motivated will always come out on top, and again, the self motivated nurse practitioners are excellent, and can do almost all of what we can do within a year or two of practice and mentoring. But it is somewhat concerning that one can come out prescribing thousands of different medications without the solid knowledge of what most of these chemicals do to the body. All in all, with the experience you all have described it seems once a motivated nurse practitioner gains footing there is nothing to worry about, if they are motivated. The general consensus seems to be that (again) education is very school specific, some are good, some are not so good (the online schooling part is rather terrifying). I am simply attempting to sum up what I have read so please excuse me if my response does not flow perfectly, but by putting it in my own words it allows me to understand it better and also portray my train of thought to you all, since we are all hopefully on the same team, at least theoretically.

These are some great responses. I do appreciate the help. Not having a centralized curriculum (if that is what is occurring) could be a concern. I am surprised they have not touched on such important topics such as the basic physical skills as presented above. I think we learned that in our first year of school and continued to do practice for the next 8 years until we could practice on our own. 700 hours does seem like a pretty quick route to be a provider also. I think by the time we graduated medical school we had around 5000-6000 hours of clinical experience, maybe a little less. But it was 50 or so + hour weeks for most of the year. We really did not count. Nonetheless much of our training was excessive, most of us could probably handle an ER (especially the non-trauma ERs) after our first year of residency. I do not know much about profit organizations besides they probably, as other for profits, seek the approval of shareholders over all else. I do not much much control over who we employ, I travel around too much, would rather not get involved, and also do not hold any administrative privileges. The big dichotomy I notice though is the personality factor, which is present across all providers. I have met MD/DO/PA/NP that all seem to think they know it all, and then the ones who are more eager to learn… the latter always succeed much more and get less lawsuits (at least our attendings told us that). I do enjoy working with nurse practitioners that like to learn, I let them do all the stuff they need to beef up their skills, especially on slow nights/days, because we were all new once. The ones that I work with that worry me are the ones that do not seem to want to bounce anything off of other providers or take constructive criticism. and this has a few times almost gotten me into trouble since my name is on all the charts. I did have to complain on one or two (which I do not like doing, and after multiple offences) and put my foot down stating I did not want them on my shift or I would go elsewhere/not resign my contract at that facility. You all seem to have answered my question pretty thoroughly, but I am not sure how to adjust the problem though. As I said, it is not super-commonplace, but I have had a couple occurrences in the past year and I have only been out of residency a year also. Again though, not to step on toes, most providers I work with are competent across all spectrums, but as you all said they may not do as good of a job sieging NP's brains (in all programs) with the needed information to provide safe care as they do pas or MD/DO. At least this is what I am hearing from the responses. To those who are able to pull off being a provider in 700 hours that is an amazing hat-trick, btw.

Hello, I am coming here to see if I can pick some information off of you all. I will state that I appreciate ahead of time the responses I will hopefully receive and hope to put them to good practice. I am an ER physician in the southeast-ish area of the US, and usually do much travelling around. I work for various staffing agencies, usually just taking the most needed bids and such. I tend to work with many different nurse practitioners and physician assistants in the various locations, mostly in the bigger ERs. The smaller ones usually it is just me since the volume is low. The reason I come here is because I am looking or some info on the education of nurse practitioners. Sine I occasionally lecture on ER topics at one of the local PA schools in front of medical students and Pas I have been able to get a thorough glimpse at the PA ED model, which really is not too much different than a condensed version of ours it seems. I did go to a med school here in the US which also has a PA program close by so I understand this aspect. I have noticed at many of the facilities I work at, a higher than average (in comparison to PA and other docs) the nurse practitioners often (not a total majority) seem to be oblivious to many aspects of ER level care. Some are unable to understand the interpretation of a basic set of lab panels, X-rays, and some are unable to suture well, if at all. There are a few that are Excellent at what we do (the term we used because we are a team and I dislike the dichotomy many use separating physician practice from other types of providers since it just stems unneeded conflict and perpetuates social gaps). I have not noticed such a large gap in practice from the physician assistants that I work with though. Nearly all of them are able to suture, interpret labs, splint, suture, read most X-rays (abdominal X-rays can be very difficult to read at times, often we physicians consult rads on these). (I am also referring to flat plate x rays not CT/MRI and the such when providing the term Xray). The gap is narrowed it seems between the PA/NP when it comes to diagnosing illness in the fast track though, I do notice it seems the PA do edge out slightly on better diagnosis (but my time is limited in the fast track, I am only there when they have a question about something, if something gets miss-triaged, or if family requests to see me, etc etc.) But the whole point of me coming here is to ask if they teach nurse practitioners during their educational adventure how to read X-ray, suture, splint, read basic lab panels, intubate, and what not. I have looked through curriculums but course names often do not tell accurate stories in any aspect of education. I would feel rather rude asking my coworkers these questions, since they may take it as demeaning and I like to maintain great relationships with the other providers. So again, here I am looking for a bit of info on what type of education they provide nurse practitioners in school (we use mostly FNPs in er) to see what you all thought of the situation. Hope I am not stepping on toes with this,,,, just looking to gather some information in an objective manner. Best wishes