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.
I would think that if the all-powerful NP lobby you previously described were "spending their money to get a peice of the pie with minimal schooling" the hundred-fold more powerful AMA would squash it readily.
And be if the AMA is worthless and liking of for their leaders, why is the NP lobby any different?
Again, you seem to pick and choose and the deflect your responses.
I guess we would have to disagree how we see the role of NP... If I or family members have anything other than a routine stuff, I guarantee you that NP won't touch us...
I guess we would have to disagree how we see the role of NP... If I or family members have anything other than a routine stuff, I guarantee you that NP won't touch us...
I am done arguing with you guys...
That's your prerogative. Good luck.
It's not an argument it's a debate. If you think of it as an argument it's because you either have already made up your mind or because you don't have any data to support you. Either way I hope it changes for you in the future, or at very least, you continue a dialogue along your journey.
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.
I can only speak for my personal experiences. I work for a large Level I trauma center as an RN. I will graduate in May with my MSN/FNP. I have received training for reading Xrays. I am also doing clinical rotations at many very rural clinics who get radiology reads quicker than I can in the ED! I am of course not familiar with every NP program, but mine does include radiology interpretation and so far every single clinical setting I have been in was able to have a radiologist interp within minutes.
The most likely diagnosis is pneumonia? What kind? What about a PE? What about bronchitis? Has your read of a chest X-ray helped limit your differential?
Why do you need a CMP over a BMP to confirm your diagnosis of pneumonia? Are you ruling out hepatitis as a source of the cough and fever?
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Sounds like you want to throw every test in the book at the PT. That's both unnecessary and also inappropriate, but it's common in NPs. If you want to order a D-Dimer, CTA, and V/Q scan go right on ahead.
NPs utilize more resources than PAs or MDs as a result of their inferior training and lack of preparation for the autonomous practice of medicine.
'The strength of our study is that it is the first to compare nurse practitioners and physicians in primary care practice by prospectively following patients with similar demographic information and baseline chronic illnesses, achieved by using a method similar to random allocation without interfering with existing practice. Another strength was that the nurse practitioners followed in this study were experienced (average, 13 years in practice). The nurse practitioners also were the exclusive primary care provider for the patients assigned to them--they did not share panels of patients with physicians, making the model of care at our institution closer to independent practice than many other settings in which nurse practitioners and physicians share panels.'
I thought a study like that was quasi impossible to achieve. It's good to see there are such studies out there... But as far as I am concerned, you did not have to bring it up for anyone with an ounce of brain to figure that out despite all the noises nursing organizations are making... You are dealing with a group of practitioners (PA/MD/DO) whose schooling and selection process are rigorous and another group of practitioners (NP) where anything goes... Online education is rampant, no admission standards etc... Curriculum of most of these programs is a joke. 500-700 hrs preceptorship where, in most instance, you find someone you know and follow him/her around. These people are making a mockery out of the system... It's going to get worse as they are getting more arrogant and think they are on par with physician and PA... The sad thing about that whole mess is that people will get hurt in the process.
Sounds like you want to throw every test in the book at the PT. That's both unnecessary and also inappropriate, but it's common in NPs. If you want to order a D-Dimer, CTA, and V/Q scan go right on ahead.
Actually, you were the one that wanted to check the CMP over the BMP for pneumonia. You still haven't told us how that is an appropriate test for suspected pneumonia....
You seem to avoid questions, so I will ask it again, tell me how your wet read of a x-ray changes your treatment course on a patient with a small lobar infiltrate in the setting of a cough and a fever?
NPs utilize more resources than PAs or MDs as a result of their inferior training and lack of preparation for the autonomous practice of medicine.
The study is 15 years old. It does not use PA's as variable, only NP, residents, and MD/DO. Its quasi (no randomization), which is OK but this could have been done experimental for less bias. The test was organized by physicians from the VA Medical Center Baltimore, which is like having Merck do studies with Vioxx... wait a second....
In any event, should NP's prove to be lax at being a provider effectively we would have no job market. I dont really see how the jobs are disappearing if PA's and MD/DO's are that much better. If thats the case, why would NPs have a job market at all?!
I don't know, but since you asked I suspect you'll likely want to research it.
I am willing to wager that less than 5% of PAs have completed a formal residency/fellowship program.
NPs utilize more resources than PAs or MDs as a result of their inferior training and lack of preparation for the autonomous practice of medicine.
The study you cited is a very small study, and to my read has a flawed design, but I am willing to bet you only read the abstract anyways. The study compared 9 NPs to 45 physicians on a very small number of patients over a relatively short period of time. They had to use a Fisher test in their statistical analysis because of the small sample size.
AndersRN
171 Posts
I guess we would have to disagree how we see the role of NP... If I or family members have anything other than a routine stuff, I guarantee you that NP won't touch us...
I am done arguing with you guys...