Should NPs become COMPLETELY independent?

Specialties NP

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wow....there are some well-informed folks on here.....yeah...no one should be downplaying another profession......that doesn't help.....I think it is truly a semantic debate here....be it DOCTOR is a professional title but we all know a euphymysm for a medical caregiver.......who here has not been called 'doc' by your patients???...but....who should be called physicians?? some seem to think we should.....well, if we're arguing for rights as advanced practice nurses why would we WANT to be called a physician....we have to be careful what we are asking for here....it is becoming a slippery slope.....we may lose the support of those who are well established and on our sides....we are NOT physicians....some NPs argue that doctors of chiropractic and optometry carry the title physician while they don't fully care for the entire patient in the same medical manner.........let the non allopathic and osteopathic practitioners of optometry and chiropractic have the title I suppose....traditionally they always have.....fighting for the same or similar RIGHTS is a different story....

I've been giving it alot of thought and really trying to see the big picture......people are getting so hung up on titles and credentials and wording and program curricula......arguing who's better a PA...an NP.....a physician...??? I used to have the theory that if you took an NP, a PA and a physician right out of school.....I think the physician is hands down more prepared, more skilled, more educated.......but, 10 years 15 years down the road....how much does experience and insight and continued learning and study develop each practitioner? could the PA end up being the brightest and most informed and best medical decision maker...?? yes, I think so....could it be the physician, the NP? sure.....doesn't it depend on all kinds of factors that take priority after education? drive? ability to integrate knowledge and medical literature? experiential and acuity exposure in practice? etc...etc.....

I think the definition on this site sums it up well........ A Nurse Practitioner (NP) is a registered nurse with advanced academic and clinical experience in diagnosing and managing most common acute and chronic illnesses either independently or in collaboration with a physician.

we just want to do what we are doing and be who we are and be rightfully recognized and legitimized for it, no???

no we don't have the same training as physicians.....could we safely take on the primary care needs of the population.......sure.....I think we could..........aren't we pretty much doing that now.....as it is....???? won't we still call on our physician and NP and PA colleagues for insight and expertise and experience when ours falls short.....???? yes...I think we will.......

I guess I kind of enjoy basically being independent and still legal having an attachment to a physician who in many cases knows more than I do......

I guess I don't need to be able to say I'M INDEPENDENT to boost my ego.......while some seem to have that need.....

I've heard some folks make a few decent arguments as to why dissolve of collaborative practice agreements is a good and/or founded thing......such as: a rightful move based on our experience and quality and scope of practice; would free up care for those who have independent clinics should something happen to their physician supervisor (death or move or stop practicing)

I guess the facts are coming in and I'm still on the fence......

can anyone else offer other reasons for why this move is so necessary or deserved....???? thanks........

Why do you need to defend wowza? Can "he/she" not defend "his/herself"? I have never meant anyone besides pompous jerks who were offended by someone calling them by their first name in any setting.

I can. Thank you. I have been busy and I am back.

so, if a PhD history professor or researching scientist is in a clinical setting.....you refer to them by their first name since they are not a PHYSICIAN...?? sounds pretty disrespectful to me, Wowza.....

I have had a few patients actually tell me they weren't "real" doctors because they were PhDs etc. I still called them doctor out of respect. I haven't had a person make me call them doctor even if they were one and I didn't realize.

If that English PhD was next to me and I was seeing a patient and they called themselves doctor X, I probably would put them in their place. I don't think anyone would actually do that because people equate doctor with physicain when you are in a hospital.

just did a debate on this subject for my health policy class...I was assigned the "con" stance. We had to argue that "nurse practitioners should NOT have full autonomy"...we lost. I thought we had some good arguments, however, they shot them all down with very good arguments. We attacked their data...they attacked ours. We argued education and residency...they had an answer to it all! Needless to say, we lost...

Do you, seriously think you could argue hard enough against DNP education and autonomy as a DNP student? Probably not- it's almost a conflict of interest. You lose the argument and suddenly your degree is vindicated. You win and then your education (and you by extension) are inferior. I mean really?

so, umm.....really curious here........why are you and any of your other anti-NP cohorts on this board again....???? this is a nurse forum and an NP link within the forum........???? I don't think I've ever truly heard the handful of you who think NPs are poorly trained clinicians EVER say anything good about them.....understandably, this is a forum for freedom of thought and opinion....but why don't you go to a medical forum with your perceptions and opinions......anyhow, I'm done responding to u and your buddy 'wowza'..... NPs will continue to thrive and fluorish and be utilized for what they are capable of doing despite your take on it.......

The same reason that nurses come to studentdoctor- boredom, curiosity and entertainment.

Most of us think that there is a definitely is a role for NPs and they are generally excellent at their job. Those jobs should have narrow roles and NPs shouldn't be independent.

If that English PhD was next to me and I was seeing a patient and they called themselves doctor X, I probably would put them in their place. I don't think anyone would actually do that because people equate doctor with physicain when you are in a hospital.

Exactly what place is it that you would put them in?

No argument? Argue semantics...

Specializes in CT ICU, OR, Orthopedic.
so, umm.....really curious here........why are you and any of your other anti-NP cohorts on this board again....???? this is a nurse forum and an NP link within the forum........???? I don't think I've ever truly heard the handful of you who think NPs are poorly trained clinicians EVER say anything good about them.....understandably, this is a forum for freedom of thought and opinion....but why don't you go to a medical forum with your perceptions and opinions......anyhow, I'm done responding to u and your buddy 'wowza'..... NPs will continue to thrive and fluorish and be utilized for what they are capable of doing despite your take on it.......

In all fairness, when I was researching my "con" stance for my debate, I went on the SDN....there are an awful lot of NPs on their network, behaving the same way that we complain about here. I really don't understand all the animosity. The fact is, if we all started respecting each other, and the rich differences that ALL health care PROFESSIONS contribute to the care of our patients, then maybe our patients would actually benefit.

It seems to me that it is a whole lot of turf wars. This is true in nursing too...NPs and PAs, CRNAs and AAs (and MDAs)...RNFAs and STFAs...seems like we all argue about the same thing! MD/DOs do not feel that NPs are educated enough. We claim we have the same outcomes...look into the outcomes of RNFAs vs STFAs....same argument. But yet we argue lack of education...hmmm isn't that the MD/DO argument as well?

We all bring something unique to the table. Should NPs become completely independent? I don't think ANY health profession is ever COMPLETELY independent. We all need some sort of collaboration. A good clinician recognizes that.

This is not to say that NPs should not be autonomous. I think that when you get "super NPs, or super MDs", the results are the same...poor.... What I am trying to say is that NPs can work very well independantly, but collaboration for things that are beyond scope is necessary. Just as collaboration is necessary when something is beyond a primary care physicians scope...Perhaps we are getting wrapped up in semantics...but there is a HUGE difference between collaboration and supervision....

You're right, we do keep arguing the same things over and over again. And neither of us are going change our minds. You're of the opinion that no evidence is needed to move forward while I'm skeptical and want evidence before okaying something. If it makes you feel better to think that I want to inconvenience the "overwhelming majority of the population," go right ahead. Not only that, I didn't make that comment in my post. It's directly from the nursing study.

http://www.bmj.com/cgi/content/full/324/7341/819

"...further research is needed to confirm that nurse practitioner care is safe in terms of detecting rare but important health problems."

quote]

I believe you are missing the point. Independent practice for NPs isn't your's to okay or deny. It isn't even up to physicians to okay or deny. This is a social issue that IS decided by politics. The problem is that you don't really understand how the system works. The fact that you want evidence is highly irrelevant.

What exactly is it that you mean that you didn't make that comment in your post? You quoted the study results and conclusion, but you are trying to say that it wasn't in the content of your post? That doesn't make too much sense now, does it?

I believe you are missing the point. Independent practice for NPs isn't your's to okay or deny. It isn't even up to physicians to okay or deny. This is a social issue that IS decided by politics. The problem is that you don't really understand how the system works. The fact that you want evidence is highly irrelevant.

What exactly is it that you mean that you didn't make that comment in your post? You quoted the study results and conclusion, but you are trying to say that it wasn't in the content of your post? That doesn't make too much sense now, does it?

Sure, independent practice shouldn't be up to him to decide but quite it definitely shouldn't be up to some politician who knows next to nothing about healthcare to decide either. The people to decide should be the board of medicine. In many states NPs are under the BOM since they are practicing medicine. It makes sense and it doesn't keep NPs from doing their job.

Whether he "understands how the system works" doesn't mean he has to accept how the system works. The system is flawed as evidenced by about 1000 things that have happened in the last decade of politics. Politicians are idiots and shouldn't be in charge of such important healthcare decisions.

Sure, independent practice shouldn't be up to him to decide but quite it definitely shouldn't be up to some politician who knows next to nothing about healthcare to decide either. The people to decide should be the board of medicine. In many states NPs are under the BOM since they are practicing medicine. It makes sense and it doesn't keep NPs from doing their job.

Whether he "understands how the system works" doesn't mean he has to accept how the system works. The system is flawed as evidenced by about 1000 things that have happened in the last decade of politics. Politicians are idiots and shouldn't be in charge of such important healthcare decisions.

Here you guys go again defending one another. Are you guys brothers or something? Just in case you hadn't noticed, I'll fill you in on what politicians are. They are the elected representatives of the people. What you are in essence saying is that the PEOPLE who elect their representatives are too stupid to choose for themselves and they need a small group of physicians to do it for them. The system is flawed because we have allowed physicians to run the show for about the last 100 years. Physicians are idiots when it comes to making policy and healthcare system calls and shouldn't be in charge of the decisions that people make about their healthcare.

Specializes in CCU,ED, Hospice.

it seems to me that it is a whole lot of turf wars. this is true in nursing too...nps and pas, crnas and aas (and mdas)...rnfas and stfas...seems like we all argue about the same thing! md/dos do not feel that nps are educated enough. we claim we have the same outcomes...look into the outcomes of rnfas vs stfas....same argument. but yet we argue lack of education...hmmm isn't that the md/do argument as well?

we all bring something unique to the table. should nps become completely independent? i don't think any health profession is ever completely independent. we all need some sort of collaboration. a good clinician recognizes that....

just as collaboration is necessary when something is beyond a primary care physicians scope...perhaps we are getting wrapped up in semantics...but there is a huge difference between collaboration and supervision....

excellent question and curious from the physicians on the board...

do physcians practice independently? are you completely autonomous in your practice of medicine?

i believe you are missing the point. independent practice for nps isn't your's to okay or deny. it isn't even up to physicians to okay or deny. this is a social issue that is decided by politics.

....

sure, independent practice ........definitely shouldn't be up to some politician who knows next to nothing about healthcare to decide either. the people to decide should be the board of medicine. in many states nps are under the bom since they are practicing medicine. it makes sense and it doesn't keep nps from doing their job.

whether he "understands how the system works" doesn't mean he has to accept how the system works. the system is flawed as evidenced by about 1000 things that have happened in the last decade of politics. politicians are idiots and shouldn't be in charge of such important healthcare decisions.

this is where i disagree... the bom of medicine is just that, a board of medicine.. i really feel that it should be decided upon by the board of nursing with input from the bom. in some states there are issues decide on by a sub committe of both bon and bom.

for many nurses, the idea the bom feel they should be the determining voice in the practice of nursing is offensive and disrespectful of the profession.

i do agee that politicians should not make the decisions about healthcare... since we all know they are not the voice of their constituents as intended. but neither should physicians.. the old adage.. leaving the fox to watch the hen house comes to mind.

another question, is medicine the only form of healthcare?

anps can effectively care for patients who require health maintenance, chronic illness management, health education and minor illnesses. but this leads to the debate are apns practicing medicine or advanced nursing.. it all depends on the color of the glasses in which you view the situation.

another question for the physicians... and i am not trying to be confrontational, just curious... what do you really know about the education and the practice of nursing? do you feel that nursing is a watered down version of medicine/medical school or do you see it as an independant profession with unique qualities?

hypothetically speaking, do you think your medical school training would qualify you to pracrice as a nurse?

( and i am sure someone will be tempted to turn this back with "nurses are not qualified to practice medicine" but as i said earlier in this post... this depends on how you differentiate the definitions of medicine and healthcare)

no flames intended, just want to see clearly where others are coming from...

Specializes in CCU,ED, Hospice.
i have had a few patients actually tell me they weren't "real" doctors because they were phds etc. i still called them doctor out of respect.

kudos, respect is where it all begins..

if that english phd was next to me and i was seeing a patient and they called themselves doctor x, i probably would put them in their place.

i am sad to say, this smells of condescension and arrogance. :crying2:

i don't think anyone would actually do that because people equate doctor with physicain when you are in a hospital.

in the past this has held as a fast truth, but things are changing.... there are a growing number of patients with higher education and a greater understanding of the nuances.

Do you, seriously think you could argue hard enough against DNP education and autonomy as a DNP student? Probably not- it's almost a conflict of interest. You lose the argument and suddenly your degree is vindicated. You win and then your education (and you by extension) are inferior. I mean really?

The same reason that nurses come to studentdoctor- boredom, curiosity and entertainment.

Most of us think that there is a definitely is a role for NPs and they are generally excellent at their job. Those jobs should have narrow roles and NPs shouldn't be independent.

Sorry to burst your bubble, but we already ARE independent in several states - more coming soon! Seriously, how do you not know this? We're even completely independent in WASHINGTON, D.C.! CRNA's are completely independent now in California. There is NOTHING you can do to change it. It is here and it is NOW!

This doesn't make sense. Most docs are against it because they don't think NPs have enough education. Instead of granting NPs independence and letting them loose on the population before there is appropriate data, shouldn't we show they can provide equivalent care? We wouldn't start prescribing a new class of hypertension med without any data to back it up. So, IMO before NPs become independent they should have to prove they can provide equivalent care to PCPs (and we are talking multicentered, over at a minimum 5-10 years). There is inadequate, incredibly biased data out there currently. Until it is shown that NPs, despite 1/10th the education of a physician, can provide equivalent care, NPs should not be independent. But clearly the politicians know a lot more...

Wowza, where do you live? Are you not aware that NPs in several states have been completely independent of physician oversight for years now? This is NOT a new phenomenon.

Make NO mistake about it, this is a $$$ issue. If physicians TRULY thought NPs needed to be fully supervised, then they would check out each patient that was seen by the NP before the patient walked out of the door.

I pay a doctor $$$ to review 10% of my charts every 30 days, because I'm forced to, since NPs aren't independent in my state. This has to be the most ridiculous law ever...those patients are LONG GONE by the time he reviews their chart. So, you call that supervision? If a patient presents in my clinic with health issues that are clearly outside my scope of practice, I refer them to the doctor!

What's really hilarious is that the docs in TX wanted to be able to supervise up to 8 NPs/PAs - how is that possible? That was shot down by the legislature. Doesn't that sound like a money making plan to you?? Now remember, as long as that doctor is on site, they get to bill at the DOCTOR rate for those NPs/PAs, even though they never see the patient. Wow, if I was a money minded doctor I wouldn't want that cash cow to go away either! TOO BAD IT ISN'T ABOUT PATIENT CARE!

Furthermore, I'm seeing comments made about my profession that are nothing short of libelous. If a physician (or anyone) ever made some of these comments about me and I got wind of it, I would most definitely sue him/her for slander. We do NOT have to tolerate this folks.

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