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.
How do you know FNP education lacks this skill i.e. X-ray interpretation?
I'm glad you can interpret PET/CT scans but really, it takes years of practice with colleagues to help you and yes the other people to help you may well be a scary FNP.
Wow I'm glad you have such strong opinions about how FNP's operate! Certainly ordering a CXR is done by clinical presentation and PMH.
Cough + fever = CXR. Unless you think you can localize a pneumonia from by percussion, egophony, whispered pectoriloquy, etc.
Regarding urgent care centers and small town ER's, they still use a radiologist.
Overnight reads. Too late for an acutely ill PT with several comorbidities.
How competant [sic] at reading films do you think you would be if you maybe see a few a week?
I'd be more competent having been thoroughly trained and tested while in school than not having any training whatsoever.
And while were on it, I wouldnt generalize the education of all FNP's to the profession. You're going to have good ones and bad ones, just like docs, and certainly like PA's. Perhaps you should remain more open minded about your opionions, you just might have to rely on one someday.
All docs receive training in X-ray reading and interpretation. So do PAs. FNPs don't which is an automatic disqualification for their ability to diagnose pneumonia or other pulmonary issues.
Specializes in Urgent Care, Occupational, Travel Medicine.
Doc,
I am an RN with a BSN currently in my second semester as an FNP student.
As a Family Nurse Practitioner we are trained as primary care providers and sometimes generalist. So our education is geared towards managing this population in the outpatient setting, treating chronic conditions and referring or consulting with another provider when it is beyond our experience, scope, education, and training, which any provider should do when they lack these requirements.
For a nurse practitioner to work in emergency or ICU they should either have a background as an RN in these specialties and an FNP, or be trained as an Acute Care Nurse Practitioner. This track is designed for these specialties. As for the Family Nurse Practitioner Education it does vary by state but the underlying core classes are universal, from pre-RN licensure to post NP Certification.
Pre-RN licensure: Anatomy (with cadavers or other animal substitutes), physiology with lab, biology with lab and thus microbiology with lab, chemistry with lab, nutritional science, psychology, developmental psychology, Statistics, and other undergraduate course.
RN(My school): Pharmacology (physiological response and indications, plus a lot of memorization), pathophysiology, medical surgical (sterile procedures, hemodynamic stability of patients, post operatively), Physical Assessment (from rhine to babinski), Psychiatric, Community health (basically epidemiology) and how to be a school/hospice nurse, Skills lab(IV's, catheterizations, suture removal, blood draws, etc.), research (ok class, how to read clinical research).
FNP: Advanced Pathophysiology and diagnostic reasoning (1 year), Advanced health assessment, Epidemiology and biostatistics, Diagnosis and management in primary care, and a minimum of 700-1000 hours of clinical rotations and a masters project or thesis. (health care policy and other non-clinical courses, fluff as I call it).
The point is an FNP curriculum is designed to create an outpatient novice primary care provider, not an intensivist, hospitalist, or emergency department provider. FNP new graduates should be hired with the understanding that they will need experience and training. I think a residency program would do the profession much justice and assist in the transition to an experienced competent provider, my two cents.
As for physician assistants their training is geared more toward inpatient and acute medical management of patients, unless you are referring to an ACNP. An acute diagnosis needs a broader management strategy and is more complex at times. This would explain the medical model of treating the underlying condition rather than the systemic issues relevant to the patient in PA programs. Many of my paramedic friends have chosen this path as it is a great extension of their knowledge, experience and education.
Cough + fever = CXR. Unless you think you can localize a pneumonia from by percussion, egophony, whispered pectoriloquy, etc.
Overnight reads. Too late for an acutely ill PT with several comorbidities.
I'd be more competent having been thoroughly trained and tested while in school than not having any training whatsoever.
All docs receive training in X-ray reading and interpretation. So do PAs. FNPs don't which is an automatic disqualification for their ability to diagnose pneumonia or other pulmonary issues.
Your lack of understanding of how the system works shows that you have limited experience in the allied health field.
1. clinical presentation = signs and symptoms. You said cough + fever = CXR. What do you think clinical presentation is, me giving them a powerpoint lecture on pneumonia?
2. No. Just no. You havent even worked in the field yet, you're still a student. Sure we use them overnight but we also use them during the day, as do critical access facilities. It takes 5 minutes to get a film back, nobody is going to die from pneumonia that fast and if they are that sick, why are they in urgent care or at the family doc when they should be in an ER? Symptom management and shipped to the next highest acute care facility when in rural situations. Should you be in an ER, you'll have someone there to read them or you can wait the 5 minutes from the RAD service.
3. Right you might be competent at reading films, hey its your license on the line right! Figers crossed you nail it every time!
4. We know where our abilities need to be, it doesnt mean an NP is unqualified at caring for a patient in any spectrum. We are trained to use our skills much like you are and this includes utilizing resources when not available and knowing when to push on to a higher level of care (something you'll experience soon enough).
You're going to have good ones and bad ones, just like docs, and certainly like PA's. Perhaps you should remain more open minded about your opionions, you just might have to rely on one someday.
This is a defense mechanism I think every NP uses to justify a profession that fails to provide the basic training to their members to function as midlevels... When the barrier to entry of a profession is so low, you will have a disproportionate practitioners that are dangerous... Using that 'there is also bad PA/MD/DO' is no good defense of a profession.
Do you known anyone who has been rejected from admission to NP school? I have been a nurse for a few years now... I have yet to meet anyone who applies to NP school and got rejected.
This is a defense mechanism I think every NP uses to justify a profession that fails to provide the basic training to their members to function as midlevels... When the barrier to entry of a profession is so low, you will have a disproportionate practitioners that are dangerous... Using that 'there is also bad PA/MD/DO' is no good defense of a profession.
Do you known anyone who has been rejected from admission to NP school? I have been a nurse for a few years now... I have yet to meet anyone who applies to NP school and got rejected.
There is no defense in truth. This statement is true for ALL careers.
I've never met anyone who has been rejected, then again all of the nurses I know who are going to NP school are competent with several years under their belts and they are more than ready.
No I don't want to. Not because I'm hiding anything but because its literally stuck somewhere in my house and I don't feel like scanning it into my computer just to prove a point.
I'm bored with this incredibly old argument of NP vs PA, who is better starting off, who is a better provider blah blah blah because its been beaten to death.
Do you known anyone who has been rejected from admission to NP school? I have been a nurse for a few years now... I have yet to meet anyone who applies to NP school and got rejected.
I've seen posts on here of people who have been rejected. Don't know the extra circumstances, but I know it happens.
hunnybaby24, BSN, APRN, NP
247 Posts
How do you know FNP education lacks this skill i.e. X-ray interpretation?
I'm glad you can interpret PET/CT scans but really, it takes years of practice with colleagues to help you and yes the other people to help you may well be a scary FNP.
Lets not kid ourselves, we aren't radiologists.