Why DNP and not MD?

AndersRN · Dec 12, 2015

Did you even read what I typed? Seriously! "Aside from surgery and a few other specific areas NP work in the same capacity as physicians"
Of course an NP wouldnt be reading a pet scan or placing a stent, thats pretty obvious. Stop trolling for no reason.

I was not trolling! Do you want an NP to be your GI practitioner? Do you want an NP to be your cardiologist? Do you want a NP to run a tertiary level ER with no ER docs? Do you want a NP to lead a PM&R department? Do you want a NP to be the person who tries to figure out a rare disease you have? Do you want a NP to be your nephrologist when your kidneys are failing? Do you want a NP to be your rheumatologist? Do you want a NP to be your rad oncologist? etc...

I certainly don't! I guess it's your health or well-being; so you can do whatever please you.

The overconfidence coming from nurses never cease to amaze me!

twozer0, NP · Dec 12, 2015

I was not trolling! Do you want an NP to be your GI practitioner? Do you want an NP to be your cardiologist? Do you want a NP to run a tertiary level ER with no ER docs? Do you want a NP to lead a PM&R department? Do you want a NP to be the person who tries to figure out a rare disease you have? Do you want a NP to be your nephrologist when your kidneys are failing? Do you want a NP to be your rheumatologist? Do you want a NP to be your rad oncologist? etc...
I certainly don't! I guess it's your health or well-being; so you can do whatever please you.
The overconfidence coming from nurses never cease to amaze me!

You have listed all specialists in your comparison. The last time I checked there were no independent care NP's that practiced as cardiolist or nephrologist. They only practice family/general medicine. Has your family MD/DO ever put in stents or read a pet scan? No. They fucntion as the ward to send you to the appropriate person.

When you go to see a specialist, they of course see you and may or may not have a PA or NP come and see you. This NP will wright orders, labs, etc. For example a patient is admitted for congestive heart failure. The ER doc consults cardiology to admit (or hospitalists to admit). The cardiologist finally sees the patient, orders an echo, some meds, and basic orders. Later in the day the NP for the cardiologist group rounds on the patient, finds the the K is low and also that the patients EF has dropped from their last admit to the hospital. They also find the left ventricle is slightly larger than previous. This echo was read by the radiologist. The patients kidney function is failing due to renal insufficiency from decreased cardiac output. The patient now needs dialysis. The NP discusses this plan with the family and the patient and they all agree to the course of action. The NP sits and writes orders to adjust the K, writes orders to adjust the patients cardiac meds, and consults nephrology for dialysis. Before leaving for the day the NP updates the oncoming cardiologist on the course of action of this patient. The NP has essentially functioned as the general practice provider for this patient for the cardiologist group. This is what we call a collaborative approach. Which is common among a lot practice environments.

Now from my logic, the NP just functioned in the same capacity as a doctor. Aside from introductions, would this patient have even known that the NP wasn't an MD or DO? I doubt it. Yes NP's dont read PET scans or place stents but as outlined above, very much function in the same capacity as a "doctor". In the end this patient got the appropriate care that they needed. It's not overconfidence, this happens all day long in my facility and in a lot of others too. I think you need to educate yourself more on what the role of NP's are in an inpatient setting, how they function, etc. They will manage your care just like a MD/DO does and coordinate the appropriate services where needed.

Should doctor prepared nurse be able to use the title? I dont see why not when functioning in that capacity. I think a lot of the issues are physicians don't want to give up any ground but with the changing of times and how money is handled, its coming.

AndersRN · Dec 12, 2015

Here is one of your statements I quoted:"Aside from surgery and a few other specific areas NP work in the same capacity as physicians"

These specialists are physicians! You were not talking about primary care...

All I said was that: Do you want a NP to be your kidney specialist, your heard specialist, ID specialist etc...?

Maybe the the words 'few' and 'same capacity' mean something different to you...

allnurses Guide · Dec 12, 2015

Here is one of your statements I quoted:"Aside from surgery and a few other specific areas NP work in the same capacity as physicians"
These specialists are physicians! You were not talking about primary care...
All I said was that: Do you want a NP to be your kidney specialist, your heard specialist, ID specialist etc...?
Maybe the the words 'few' and 'same capacity' mean something different to you...

I for one would have no problem going to an NP that specialized in those areas.

Other than your opinion do you have any research to backup any of your statements about the lack of quality of NPs.

twozer0, NP · Dec 12, 2015

Here is one of your statements I quoted:"Aside from surgery and a few other specific areas NP work in the same capacity as physicians"
These specialists are physicians! You were not talking about primary care...
All I said was that: Do you want a NP to be your kidney specialist, your heard specialist, ID specialist etc...?
Maybe the the words 'few' and 'same capacity' mean something different to you...

I left physicians open and didnt articulate on any specialists. Its pretty clear that an NP wouldnt be doing specific things outside of their scope such as surgery or specific diagnostic tests/reading. In mostly every other area, they are indeed functioning in that role, even in specialist groups. As I type this, I just had the ACNP come and evaluate a patient that was put on bipap for idopathic pulmonary fibrosis and low sats in the post op setting. She wrote orders etc. Outside of an interventional cardiologist doing caths, what do you think they do that is different than the NP working in their office?

Bluebolt · Dec 12, 2015

I left physicians open and didnt articulate on any specialists. Its pretty clear that an NP wouldnt be doing specific things outside of their scope such as surgery or specific diagnostic tests/reading. In mostly every other area, they are indeed functioning in that role, even in specialist groups. As I type this, I just had the ACNP come and evaluate a patient that was put on bipap for idopathic pulmonary fibrosis and low sats in the post op setting. She wrote orders etc. Outside of an interventional cardiologist doing caths, what do you think they do that is different than the NP working in their office?

Working in the ICU I've seen this same thing many times. Of course a brand new NP I regard with respect but caution just like I do for first and second year residents. Although once the NP has some years of specialty training usually directly with the pulmonologist, oncologist, cardiologist (insert ologist here) I've found them to be very knowledgable and relevant in their field. Usually 95% of things you'll ask them for or need they can do, the other 5% they'll defer to the physician they work with.

Of course surgical intervention is a different area. CRNA's are trained and statistically proven to be just as skilled at nerve blocks, intubations, central line insertions, floating a PA cath, maintaining the hemodynamics of critical patients, etc. Although I don't think anytime soon an advanced practice RN will be performing a CABG or whipple.

To be fair though, I know many physicians who would be just as inadequate at surgical intervention as a CRNP. It is a specific specialty that you go into after medical school, those who don't take that path are not trained or qualified for surgical interventions.

AndersRN · Dec 12, 2015

i guess there will come the day when PCP will put in their consult 'NP GI consult'... I know some physicians who have tried to send their NP to take care of consults... And it has created some issues where I work since I started seeing increasingly PCP put in their consult orders: 'cardio consult, not to be seen by NP/PA'.

Which make sense IMO because when you put a consult, you are asking for an expert opinion... An NP that probably has an online degree with a lot fluff courses plus 500-700 hours preceptorship is not an expert.

All I am saying is if my heart is failing, I would like a cardiologist to do the first consult... Maybe I let the NP involve the in management depending how competent I feel he/she is...

allnurses Guide · Dec 12, 2015

i guess there will come the day when PCP will put in their consult 'NP GI consult'... I know some physicians who have tried to send their NP to take care of consults... And it has created some issues where I work since I started seeing increasingly PCP put in their consult orders: 'cardio consult, not to be seen by NP/PA'.
Which make sense IMO because when you put a consult, you are asking for an expert opinion... An NP that probably has an online degree with a lot fluff courses plus 500-700 hours preceptorship is not an expert.
All I am saying is if my heart is failing, I would like a cardiologist to do the first consult... Maybe I let the NP involve the in management depending how competent I feel he/she is...

Your opinion your choice who you decide to see.

AndersRN · Dec 12, 2015

Your opinion your choice who you decide to see.

It's always anyone's choice, but when one has some knowledge in healthcare as I have, you know who are competent and who are not!

allnurses Guide · Dec 12, 2015

It's always anyone's choice, but when one has some knowledge in healthcare as I have, you know who are competent and who are not!

I see so would you care to share this scientific knowledge through the use of peer reviewed research that supports your opinion that NPs are inferior to physicians that you seem to claim in every post.

Bluebolt · Dec 12, 2015

I see so would you care to share this scientific knowledge through the use of peer reviewed research that supports your opinion that NPs are inferior to physicians that you seem to claim in every post.

And again the discussion is brought to a screeching halt when asked to prove inflammatory and bias opinions. We could circle this topic over and over always ending in this outcome.

AndersRN · Dec 12, 2015

I see so would you care to share this scientific knowledge through the use of peer reviewed research that supports your opinion that NPs are inferior to physicians that you seem to claim in every post.

I don't need to conduct any research to show a NP is not superior than a cardiologist... That is just common sense!

The same way one does not need to conduct a research to compare a CNA vs a LPN competency...