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 can tell you that the NP background is severely lacking in basic sciences way before graduate education.
Some schools may be different but my graduate education had ZERO biochem. I had a year of biochem in my other profession as well as all the same pre-meds you had. NP's are not required to have any of that.
This isn't entirely true. I would have to do some research to try and find actual numbers but most BSNs moving into NP programs have typical undergraduate science preparation (chemistry, psychcology, microbiology, biology/physiology, statistics) as part of established curriculum. Direct-entry NP students have pre-requisites prior to matriculation that include most basic science education. I teach both medical and nursing students and at the graduate level I find they all have a basic understanding of science and the scientific method.
Not all programs have biochem requirements, nor do all medical schools or PA schools. Could it help, sure, but I am not sure it is really necessary to practice effectively/safely.
Nursing education upon which NP programs are based are more clinical and practical than science based. So they are taught to diagnose and treat more as an apprentice than a scholar although some of the programs are heavy on research. Their backgrounds tend to be dictated more by their clinical preceptors (and experiences) than the college curriculum they completed.
I am not sure what NP program you went to but mine was so focused on EBP that I worried they lost track of the art of medicine. Approaching the practice from a scientific position is important but so is being able to treat both the individual and the disease, which is what NPs do very well (and this can be seen in outcome studies).
Do you feel the chiropractic model is fully devoted to scientific practice moreso than NPs?
So in essence you may have a very competent NP who doesn't know "why" they are doing something but does know exactly "what & when" to do it.
In all honesty, this is true of every type of provider.
Have you read any research comparing NPs and physicians relating to adhering to the scientific guidelines for practice?
NP's understand the reports but will have difficulty reading, interpreting, and taking x-rays.
You are right that I bet most NPs would not be exceptionally efficient in taking an x-ray; not sure most PAs or physicians would too, save for perhaps House MD and his team that do all their own work. Have you read any research on the topic? Or are you just assuming they will have difficulty?
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.
Well done coming to a nursing site to state that NPs tend to be poorly trained compared to PAs.. I think you are not actually looking for answers as you stated that hiring is not your realm and you are a temp worker for the most part.
As mentioned, there are innumerable different courses and curriculums; it's not standardized so there's no one answer to your enquiry, if it actually is a question. I can guarantee I know more of what you mentioned than an FNP, because I studied ACNP with a critical care focus. You must also take into account the pre-NP experience and education. To date I have completed 12 years of post high school university education, and when I started my NP degree I already had 12 years experience in critical care, as well as postgraduate education in critical care, research and education, among other things. I would therefore back my knowledge and experience over any PA or resident - even if I'm not as good as suturing.
I am not sure what "they may not do as good of a job sieging NP's brains... as they do pas or MD/DO" means.
I am an MSN/FNP student. I am also an IMG who passed USMLE and even did a year of IM residency before turning to nursing. It is another story why I did it, but I can see things from different perspective.
To begin with, there are different doctors, nurses, PAs and so on. During my residency year I was NEVER required to interpret X-ray beyond the very basics, let alone CT or MRI, although I could order them any second. I was required to explain in details why I would want to order them, what exactly I was expecting to see, read interpretations and make conclusions, sometimes quite intricate, of what they could mean in context of the patient's symptoms, but that was that. I did total one big arterial stick and only started to do lines because I was following seniors like a tail. I never had to suture or cast or even put an IV in. Right now (in acute care, not ER) I have more than enough PAs and MDs who seem to never in their lives do anything "technical" at all. And do not even get me started on physical assessment skills. There are doctors who do not even auscultate heart when told about new (!) murmur in chronically septic (!) patient, leaving alone correct auscultation of all 5 points in 3 positions plus vessels. They just order ultrasound.
Second, I am seeing quite enough physicians who are experts in their own area but feel extremely uncomfortable if things start to run even a little bit unpredictable way. I work with very complex patients and sometimes I have to literally spend my day calling one consultant after another and exasperating that a hospitalist "cannot" manage a patient with fever AND positive Kernig just because 1) fever is going under ID service and 2) positive Kernig is going under Neuro service. I also have to remind some doctors, on pretty much regular basis, to please discontinue all b-blockers if patient is getting Levophed drip, as just one example.
I find nursing education deficient, on Bachelor's as well as so far on Master's level, that's why I got basic science textbooks (Lang's patho, pharm and biochem) and read them in my spare time to dust off my brains. They are not at all difficult to understand, BTW. But I have high suspicions that no amount of scientific knowledge will teach a person how to think clinically. Any technical skill can be taught to almost anyone given the right circumstances, but critical and clinical thinking is another thing. Unfortunately, critical thinking taught in BSN programs have nothing to do with what is required in real life, leaving alone provider's level. PAs do not have to make this transition, and I think this is the reason why they are perceived as "much easy to work with" by MDs. For many RNs I observe, moving from "problems" and care plans and, God forbids, policies governing their every breath and move to simple scientific explanation of, for just one example, why and how sepsis can cause elevation of AST/ALT and what does it mean implies a psychological trauma of a sort. Many of them, to put it mildly, do not much like people who tend to explain how human body works, and this discourages other nurses from furthering their education.
I am absolutely sure that I could learn how to do sutures and lines if I need and want it. We have an optional class where FNP students who want these skills can learn basics in lab and later add a bit on clinical. We also have X-ray reading basics now and going to continue to do them through the program. I do a whole lot of my own physical exams (I am actually supposed to do real head-to-toe on every patient every shift, so I am just using the opportunity). But what I enjoy most is that my program pushes us hard to thinking as providers, not as nurses, and where they let us slack, I just do it myself :)
Because I am the sole provider for my family. Hopefully by the time I start clinicals I won't be. Life continues, whatever the dream.
I am a firm believer that for most NP students in clinical portion of the program should work as little as possible and spend as much time involved with their patients as possible.
Remember, you want those physicians to respect you, and they sacrificed their entire lives for 7+ years while they trained. NPs, I hope, can find a happy medium and still provide quality care.
I read the first page of this thread and the OP summed up my thoughts about NP's and NP education pretty well. As I am about 75% through NP school I can say I am disappointed in it and understand exactly why some physicians prefer PA's and why NP's get trashed on SDN. There is far too much theory and far too little hard science. They stress the difference between the role of a nurse and that of a provider but give far too much credit to bedside experience which in the instances of many of my student peers is irrelevant to their graduate track. 720 clinical hours are required at my institution. How long does it take a PGY-1 EM resident to hit that... 3-4 months??? And there is zero residency requirement for NP's following graduation.
I used to drink the kool-aid and support NP autonomy. At this point I can say I am wholeheartedly against it. Until nurses demand their education to be on par with their peers the level of respect and responsibility will rightfully be diminished.
I read the first page of this thread and the OP summed up my thoughts about NP's and NP education pretty well. As I am about 75% through NP school I can say I am disappointed in it and understand exactly why some physicians prefer PA's and why NP's get trashed on SDN. There is far too much theory and far too little hard science. They stress the difference between the role of a nurse and that of a provider but give far too much credit to bedside experience which in the instances of many of my student peers is irrelevant to their graduate track. 720 clinical hours are required at my institution. How long does it take a PGY-1 EM resident to hit that... 3-4 months??? And there is zero residency requirement for NP's following graduation.
I used to drink the kool-aid and support NP autonomy. At this point I can say I am wholeheartedly against it. Until nurses demand their education to be on par with their peers the level of respect and responsibility will rightfully be diminished.
How much of that 700 hours have you completed at this point? Have you voiced your concerns directly to your program? If there is too much theory and not enough "hard science" than students will have a difficult time passing the board exams.
I see no need to make NP education/preparation exactly like physician education/preparation. If it were, what would be the point? NPs offer a cost-effective and quality alternative to a shortage of prepared physicians. If NPs were made to undergo a similar residency than that cost-effective benefit would diminish. As of now, well a few years ago technically, NPs had similar quality outcomes as physicians. If the outcomes are the same, what's the motivation to change the education/preparation?
That being said, I have concerns, as many other due, about the quality of some of the new, cheap, fast, and easy NP schools that are popping up. I hope there will be a response from the accrediting bodies regard this as well as some of the other concerning practice such as non-secured preceptorships.
I am a RN I have worked with many NP. The one thing I have found is some of the NP have no nurse training, they went straight from high school to NP school. If they did this they had book knowledge but not hands on knowledge it scared me to work with them. Sometimes I had more knowledge than they did. I checked into NP programs for myself and found the requirements ranged from no need for any medical training prior to starting classes to needing 5 yrs of ICU training needed. I feel a standardized curriculum is needed for NP degrees just like RN degrees
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 can only hope to work with physicians like you when I graduate. Thank you for taking the time to inquire and contribute. Your attitude is refreshing.
I work with NP PMHNP and FNP they are super professional, knowledgeable and our MD's DO's discuss complex cases together with them. Some FNP know more then some our MD's. (more updated) All this discussion is so subjective.
I'm not a NP, but my PCP is an FNP - she's awesome, and not only interprets my labs, but I would trust her to suture any where but my face (I'd rather have a plastics specialist do that). She can also interpret xrays. Not sure if NP training varies from state to state, but Susanna was trained in AZ, and has been an FNP longer than I've been an RN (I graduated 1993). I trust her with every aspect of my health, even my life, and I have chronic health conditions. She's super! Perhaps the questions you seek vary with the experience of the individual NP?
(For those who do not know, Ms. Tina Jones is a simulation patient used by Shadow Health, an online assessment training company used by many NP and medical schools for basic assessment training).
Ms. Tina Jones is in her mid-20th, AA, obese, hypertensive, with DM type II and mild asthma, and a slew of other minor ailments for which she "is seen" in urgent care-like setting. Family history of heart disease. No primary care provider. No regular treatment for DM and HTN.
Now, how many of just such Tinas come through ERs and UC centers daily in this country? Every health care provider, physician and down to possibly MAs, know how it all gonna to end. Tina is in her mid-20th now and feels just fine. If her health is continue to be "managed" like it is right now (i.e. no good glucose control, no weight control, no BP control, little if any exercise) she will get the first calls from her eyes and her kidneys in the next 15 to 20 years. She will have a pretty good chance to celebrate her 65th birthday being hooked to dialysis machine, and she will be lucky indeed if at this date she sees her birthday cake and still has both legs and not living in excrutiating pain. She will probably die from heart disease before or shortly after her 70th birthday.
We all know it. There are tons of evidence around to confirm this prognosis. We also all know what needs to be done to avert it and let Tina live long and healthy life. In short, someone of us needs to get Tina to understand the seriousness of her situation and help her to manage her own health. Tina needs to be seen in office at least once a month, for the beginning. She needs to be spoken with, encouraged, taught, motivated endlessly. One needs to call her once in a while to make sure she checks her BP and sugar. She needs info about communuty programs, affordable gym classes friendly for African American women, maybe even some grocery coupons for fresh produce.
Now, the health care provider who will do it all for Ms. Tina may not necesserily know the molecular mechanism of ACE inhibitors action. It would be nice addition, but not mandatory. What would be mandatory is his or her ability to connect, educate and motivate Ms. Tina, as well as willingness to speak and ability to answer questions the way Tina understands, because what we need is Ms. Tina taking her lisinopril DAILY as a prayer. Same (or worse than that) goes about Ms. Tina's diet, blood glucose control, etc.
Doing a quick physical and writing a half a dozen scripts in ER will not help Tina. Only long-term, systemic, relentless and thankless care will, and I do not foresee doctors standing in lines willing to do this kind of jobs.
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BostonFNP, APRN
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This isn't entirely true. I would have to do some research to try and find actual numbers but most BSNs moving into NP programs have typical undergraduate science preparation (chemistry, psychcology, microbiology, biology/physiology, statistics) as part of established curriculum. Direct-entry NP students have pre-requisites prior to matriculation that include most basic science education. I teach both medical and nursing students and at the graduate level I find they all have a basic understanding of science and the scientific method.
Not all programs have biochem requirements, nor do all medical schools or PA schools. Could it help, sure, but I am not sure it is really necessary to practice effectively/safely.
I am not sure what NP program you went to but mine was so focused on EBP that I worried they lost track of the art of medicine. Approaching the practice from a scientific position is important but so is being able to treat both the individual and the disease, which is what NPs do very well (and this can be seen in outcome studies).
Do you feel the chiropractic model is fully devoted to scientific practice moreso than NPs?
In all honesty, this is true of every type of provider.
Have you read any research comparing NPs and physicians relating to adhering to the scientific guidelines for practice?
You are right that I bet most NPs would not be exceptionally efficient in taking an x-ray; not sure most PAs or physicians would too, save for perhaps House MD and his team that do all their own work. Have you read any research on the topic? Or are you just assuming they will have difficulty?