I've been accepted to an Accelerated BSN program for career-changers. Yes, I also applied to PA schools, but I am wait-listed at both of them, so I am choosing the BSN (and after RN experience, MSN). Let me say that I do NOT think NPs are inferior to PAs; I applied to both because as someone with a BS in biology, PA school makes more sense time-wise. I am happy to go to nursing school.
So, back to the title. Yes, someone said that NPs don't practice medicine, they practice nursing. What? First, what does this REALLY mean? Second, I understand the difference between the medical and nursing models but do they make any meaningful difference in your career post-graduation? In the same thread, someone also said that NPs have poor diagnostic skills because of the way they are trained. These comments really heated me up. Please tell me this sort of animosity between the professions is mostly just online and not real life!
I think of the time spent in the cadaver lab (when I hear the MDs talk) vs my time with a cat; the time spent in residencies, the time spent preparing to present a patient to a preceptor or colleague (touched on very little in my own schooling, but a focus of a clinical with an MD, not as big of a focus with my NP clinicals), time spent with labs - not just looking them up, or getting a 30 minute lecture or a book, but really diving into those day in and day out, the knowledge of the systems and ability to know such obscure things without having to look it up on UTD and having it be correct when I do later, etc. I very much know that I don't practice medicine, and perhaps this is just me, but don't feel I'm on an equal playing field with my MD or PA colleagues - simply because my schooling was so different. Now, as I have my 1st year under my belt, I know where my weaknesses are, and am actively working to get up to speed so I understand some of the discussions they have when it comes to the finer points of "medicine." I may not be the only one who feels this way, but I find it unfortunate that too many NPs will complain about schooling, preceptors, etc. but not speak up about the fact that we are NOT physicians, and really shouldn't be thought of as "about the same, just the same, almost like" etc. My RN experience did NOT prepare me for being a practicing NP in so many ways; my education helped. But the majority of what I've learned so far has been OTJ training, as a physician would receive during residency. In 10 years I might feel differently, but not now. On that same note, however, one of the physicians I work closely with values my nursing experience and often shares that with me, because of what I do bring to the team with my own training and education. My 2 cents.
Thank you so much for your honest appraisal! It takes a lot of humility and awareness to be able to talk about weaknesses like that. I'd actually really like to talk to you more. Do you mind if I message you?
I think of the time spent in the cadaver lab (when I hear the MDs talk) vs my time with a cat; the time spent in residencies, the time spent preparing to present a patient to a preceptor or colleague (touched on very little in my own schooling, but a focus of a clinical with an MD, not as big of a focus with my NP clinicals), time spent with labs - not just looking them up, or getting a 30 minute lecture or a book, but really diving into those day in and day out, the knowledge of the systems and ability to know such obscure things without having to look it up on UTD and having it be correct when I do later, etc. I very much know that I don't practice medicine, and perhaps this is just me, but don't feel I'm on an equal playing field with my MD or PA colleagues - simply because my schooling was so different. Now, as I have my 1st year under my belt, I know where my weaknesses are, and am actively working to get up to speed so I understand some of the discussions they have when it comes to the finer points of "medicine." I may not be the only one who feels this way, but I find it unfortunate that too many NPs will complain about schooling, preceptors, etc. but not speak up about the fact that we are NOT physicians, and really shouldn't be thought of as "about the same, just the same, almost like" etc. My RN experience did NOT prepare me for being a practicing NP in so many ways; my education helped. But the majority of what I've learned so far has been OTJ training, as a physician would receive during residency. In 10 years I might feel differently, but not now. On that same note, however, one of the physicians I work closely with values my nursing experience and often shares that with me, because of what I do bring to the team with my own training and education. My 2 cents.
mom2cka, I value your opinion because you have been through the schooling and are doing the job. However, two things come to my mind. First, you seem to be a bit hard on yourself. All clinicians seek advice from more senior clinicians, especially when starting out. And even experienced MD's often look things up.
You have only one year of NP experience so if anything you should be compared to a first year resident, not an attending MD, and even that would be unfair as medical school is longer and tougher than NP school. You should have a supervising MD and you should not be ashamed that you have to ask for advice - that's part of the deal. Secondly, what is your specialty? Are you a hospitalist NP? If you feel completely out of your depth perhaps you should start with a less challenging specialty. And you should be dealing with less complicated cases both because you are new and because you are an NP. Every new job or promotion is hard. On the job training is good and necessary for anyone unless they are a genius.
I still think you practice medicine. This doesn't mean you are "almost a doctor" or "pretending to be a doctor." When they triple your salary up to what a doctor makes then you can start feeling guilty for not knowing everything! :)
You can correct and educate me if I am way off base here. But this is how it looks from where I stand.
Specializes in Cardiac, Home Health, Primary Care.
Thanks Lemon Bars for the reminder that we all start out somewhat similar (only somewhat). In my interviewing process one of the doctors I will likely work with soon only finished all of his schooling 3 years ago. He seemed very down to earth on what to expect of me and I told him of my concerns, he told me things about what his concerns were starting out and they were pretty much on par. He was very reassuring (as all of the MD's have been towards me) that none of us know it all, we won't always get it right on the first try, primary care can be intimidating, and to use resources available.
I know I'm not a doctor and wasn't trained to be a doctor. I am a little jealous of some of the cool stuff they got to do (cadaver lab as mentioned by a PP) and wish NP school had more science based classes vs nursing theory and such....but I am still proud of the career I'm about to start.
If I had to do it all over again I might consider PA school more due to it being more science based buuuut I also enjoy supplementing my education on my own time by delving deeper into subjects (I like Coursera and have several books regarding patho and micro that I have been browsing).
Thanks for your feedback :) I probably am hard on myself - but I don't feel incompetent at work, see patients on my own in the clinic and hospital, and have great colleagues to help advise me when I need help. My concern is - NPs are being trained that they can go out and practice "just like a physician" once they are licensed. Open their own practices. Work without help (no supervising or collaborating physician). Our time as an RN helps, but many who are getting their MSNs and DNPs now don't have that. And it is very different being an RN when you compare it to what we do as NPs. We aren't trained to transition into a residency program - we are trained to hit the field running, and I don't feel that we are getting the experience or training in school to do that. Just take a look at how many people struggle to get clinicals - a good clinical can really make a difference. I practice in a specialty field I have nursing experience in, and enjoy - I don't feel out of my depth, I just don't feel equal to a physician and I think that's OK to admit. In fact, I think NPs need to talk more about that. There's a vocal group that talks about how good we are and how we can compete against physicians in so many ways - and in some, we do, but when it comes to the medicine and the science - I think the NP programs are extremely lacking. My 2 cents :)
A cadaver is a waste of time for me. I practice on real people. And I do not want to practice like a physician, and you might not either, if you listen to patient's complaints.
Specializes in Cardiac, Home Health, Primary Care.
I just think dissecting a cadaver would be fun in a morbid kind of way. And when I see stuff in real life I can relate it to what I'm learning and why this happens better.
And yeah I have many patients who feel like cattle being herded in docs offices. My town is finally getting more NP's (we have a local PA school) and I think many are finally seeing the light.
Actually the office I'm interviewing at has several docs. A few of them are INSANE amounts of patients in a day. Sure they have scribes but I still worry about the quality of care when you allot less than 5 minutes for the patients appointment, education, documentation, etc.
Thankfully they say I can dictate how many I see. The PA they have had for a year sees 20-30 in a 10 hour day which is much more doable.
I have been a practicing nurse for almost 15 years. During that time, an extensive bit of my experience has been within teaching facilities in which I worked side-by-side with fellows, residents, PA students, APRN students, and RN students. I have heard the debate concerning APRN's practicing medicine too many times to count.
As a current student in a family nurse practitioner program I would like to finally throw my opinion on this debate into the ring.
**
DO's, MD's, and PA's are taught reactive treatment. They specialize in treating a disease process that has manifested and is active.
NP's/APRN's are taught proactive treatment. We specialize in health, lifestyle, and behavioral interventions to prevent disease and illness.
** This is an abstract of thought, not a definitive definition for all DO's, MD's, NP's, and APRN's
I believe each group can do the work of the other (medicine vs nursing), but I believe MD's/DO's/NP's have a slight advantage in some areas thanks to high levels of biochemistry/biology training. I believe APRN's have slight advantage towards holistic care and prevention as these are two components of throughout the core nursing philosophy. I will also state that the best and most effective health care teams I have had the privilege of working with are composed of a variety of providers (MD's, PA's and APRN's) in which no one is the defined leader. Instead each member has a 51% vote on matters. If a PA or NP does not agree with a MD's plan of care, they can stall the action until it can be discussed and a mutually agreeable solution can be found. When this model is used in a professional manner, it is quite effective. Unfortunately some want to be the boss or refuse to concede to group decisions as a means to subvert authority from the group.
In the end, nursing and medicine follow similar but slightly different paths to end at a mutual goal: to provide care and support to our patients, families, communities, and state/country in regards to health and well-being.
APRN's are not going away. Several states are on the move to have PA's follow a path similar to APRN's for an autonomous role. Some MD's and DO's are resistant to change, but change is inevitable.
Thank you for taking the time to read this. Have a good day.
A cadaver is a waste of time for me. I practice on real people. And I do not want to practice like a physician, and you might not either, if you listen to patient's complaints.
Can we not do that please? I hate the generalization that doctors don't take the time to listen to their patients or that they only "treat the disease, not the person." Sure, there are bad docs and good docs, just like in any profession, but let's not disparage or make sweeping generalizations about our colleagues.
And as far as the cadaver comment- it's not a replacement for practicing on real people. But it's an incredibly valuable experience, if you are lucky enough to get the chance to work on one.
Specializes in Occ. Hlth, Education, ICU, Med-Surg.
Physicans, PAs, and NPs can all legally diagnose and treat acute and chronic illness, order and interpret diagnostics tests, and prescribe medication. Research has demonstrated comparable outcomes for all groups.
The rest of it really is semantics. In simple terms the medical model is aimed at treating disease while the nursing model is aimed at treating both disease and the patient's response to disease. Only physicians go to medical school. Physician assistants have an abbreviated medical education that was designed to work under a physician guidance/supervision. NPs have advanced nursing education aimed at independent but collaborative practice with all members of the health care professions.
mom2cka
329 Posts
I think of the time spent in the cadaver lab (when I hear the MDs talk) vs my time with a cat; the time spent in residencies, the time spent preparing to present a patient to a preceptor or colleague (touched on very little in my own schooling, but a focus of a clinical with an MD, not as big of a focus with my NP clinicals), time spent with labs - not just looking them up, or getting a 30 minute lecture or a book, but really diving into those day in and day out, the knowledge of the systems and ability to know such obscure things without having to look it up on UTD and having it be correct when I do later, etc. I very much know that I don't practice medicine, and perhaps this is just me, but don't feel I'm on an equal playing field with my MD or PA colleagues - simply because my schooling was so different. Now, as I have my 1st year under my belt, I know where my weaknesses are, and am actively working to get up to speed so I understand some of the discussions they have when it comes to the finer points of "medicine." I may not be the only one who feels this way, but I find it unfortunate that too many NPs will complain about schooling, preceptors, etc. but not speak up about the fact that we are NOT physicians, and really shouldn't be thought of as "about the same, just the same, almost like" etc. My RN experience did NOT prepare me for being a practicing NP in so many ways; my education helped. But the majority of what I've learned so far has been OTJ training, as a physician would receive during residency. In 10 years I might feel differently, but not now. On that same note, however, one of the physicians I work closely with values my nursing experience and often shares that with me, because of what I do bring to the team with my own training and education. My 2 cents.