Being an APRN is like practicing medicine

[InfoNerd101]

I've heard being an APRN despite still being called a "nurse" is not really like practicing nursing anymore at all, rather it's more like practicing medicine and being a doctor.. Is that true?

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[image187]

No it's totally different. All your patients have better satisfaction

 

[InfoNerd101]

No it's totally different. All your patients have better satisfaction

Totally different than nursing or medicine?

 

[BreathDeep]

I've heard being an APRN despite still being called a "nurse" is not really like practicing nursing anymore at all, rather it's more like practicing medicine and being a doctor.. Is that true?

Unless diagnosis falls into the realm of nursing (which it doesn't) then yes, it is on the surface like practicing medicine.

Your basic nursing duties - Bathing, cleaning, feeding, medication administration/titration, IV placement (usually) don't happen (unless you're bored and being really nice). NP duties will include taking a history and physical, diagnosis, ordering treatment, fighting with insurance about said treatment, lab and radiology interpretation, physical assessment, etc.

In the real world this is medicine. In the alternate universe of most BON's they call it "advanced nursing". Don't be fooled, it's still medicine, it's just called advanced nursing so that the BON can control NP's and the board of medicine can't.

 

[elektroshok]

noctors interpreting radiology - thats comical...

 

[BreathDeep]

noctors interpreting radiology - thats comical...

Indeed. It's sad that lowly RT's like myself and my coworkers regularly have to interpret CXR's because the Doc is at home asleep and the house NP's are unable to do it appropriately. Maybe it has something to do with their one class on X-ray interpretation?

That is beside the point however. It doesn't change the fact that it still falls within their scope (at least in my location) to order and interpret radiological images and then order treatment/intervention based on said interpretation.

 

[elektroshok]

My point was that it's scary that a) that's in their scope of 'practice' and B) they think they are okay at it

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[BreathDeep]

And my point was, in my own long winded way, that I agree with you entirely.

 

[W19]

Indeed. It's sad that lowly RT's like myself and my coworkers regularly have to interpret CXR's because the Doc is at home asleep and the house NP's are unable to do it appropriately. Maybe it has something to do with their one class on X-ray interpretation?

That is beside the point however. It doesn't change the fact that it still falls within their scope (at least in my location) to order and interpret radiological images and then order treatment/intervention based on said interpretation.

That's scary!

 

[NYCGuy86]

Indeed. It's sad that lowly RT's like myself and my coworkers regularly have to interpret CXR's because the Doc is at home asleep and the house NP's are unable to do it appropriately. Maybe it has something to do with their one class on X-ray interpretation?

That is beside the point however. It doesn't change the fact that it still falls within their scope (at least in my location) to order and interpret radiological images and then order treatment/intervention based on said interpretation.

Are you saying the NPs at UCSF can't appropriately interpret CXRs? And the RT provides the interpretation for the NP to make provider-level clinical decisions? Are these the ICU NPs?

 

[BreathDeep]

Are you saying the NPs at UCSF can't appropriately interpret CXRs? And the RT provides the interpretation for the NP to make provider-level clinical decisions? Are these the ICU NPs?

Oh no, not UCSF. The ICU NP's there were, for the most part, quite solid and I enjoyed working with them. I actually left that hospital recently and took a job in a smaller, "community-ish" hospital. Which is...different.

However, yes, I am saying that the NP's at my current facility can't interpret CXR's very well. Or maybe they can but they just have no idea what the appropriate respiratory intervention is? I honestly don't know which it is, but I know that it always ends the same, with some sort of inappropriate order. Not to mention the ventilator changes they will suggest based off of said interpretations.

Luckily at my current facility the ventilators are driven entirely by RCP protocol and they are not allowed to change anything, only make suggestions which can be ignored (only the intensivist himself may override/change anything). I suppose it probably bothers me more because I worked with excellent NP's before, but I look at these new people and all I can think is jesus, how the hell did you graduate from anything?

 

[PsychMajorUndergrad18]

I feel like the argument that NPs can practice medicine is like Psychologists saying that they practice psychiatry (which doesn't really happen except for in the two or so states that give psychologists prescribing privileges) and saying that a Professional Counselor can practice psychology and conduct advanced psychological tests like a Psychologist with a PhD and anywhere from 2-6 years of post-doctoral training. I understand the need for NPs to be hired to handle less severe illness and injuries but NPs cannot practice the full gauntlet of what a Physician with a MD and at least 3 to 4 years of medical training can do (without counting fellowship which adds a extra 2 or so years to give a doctor the ability to become more specialized in his/her practice)

If you all wanted to practice medicine than go for a MD or DO. Don't say that you practice medicine because in all honesty (and me saying this as nicely as I can) you do not. You practice a form of advanced nursing practice that draws in some medical practice. So please excuse me for my bluntness but I am just stating my opinion in regards to this issue.

 

[d2305]

I've missed small infiltrates before, and I'm glad radiologists read them now. It's never good news when they call.

 

[sarjasy]

noctors interpreting radiology - thats comical...

Yeah, we should follow the example of the EM docs who look at the chest film and say (to themselves) "I dunno know," then rx Levaquin and tell the patient to follow up with their PCP in 3 days. There's a reason that practices/groups are using more rad overreads/making them mandatory. It's because too many docs wiff on the films they shoot.

 

[sarjasy]

My point was that it's scary that a) that's in their scope of 'practice' and B) they think they are okay at it

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Back at you. See my previous post. Do you think you can spot every hand/wrist fx? Every ankle/foot fx? Every lymphadenopathy or infiltrate on CXR? The subtle perf on an acute abdomen? There's a reason for rads overreads, despite the fact that x-ray interpretation is within the scope of practice for FM's, EM's, IM's, etc.

Oh, and thanks for sharing the model number of your phone and the app you use to make your posts. You should add the tagline, "Please forgive my terrible grammar and spelling - I'm posting with my mobile phone."

 

[elektroshok]

lym

Back at you. See my previous post. Do you think you can spot every hand/wrist fx? Every ankle/foot fx? Every lymphadenopathy or infiltrate on CXR? The subtle perf on an acute abdomen? There's a reason for rads overreads, despite the fact that x-ray interpretation is within the scope of practice for FM's, EM's, IM's, etc.

We might be saying the same thing since I'm in radiology and I agree there's a reason for rads.

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[sarjasy]

I feel like the argument that NPs can practice medicine is like Psychologists saying that they practice psychiatry (which doesn't really happen except for in the two or so states that give psychologists prescribing privileges) and saying that a Professional Counselor can practice psychology and conduct advanced psychological tests like a Psychologist with a PhD and anywhere from 2-6 years of post-doctoral training.

Thanks for sharing how you "feel." Any facts/research to back it up, or is it just how you "feel?"

 

[Mad Jack]

It's like medicine, but you have no idea what you're doing.

I joke, I joke...

 

[sarjasy]

We might be saying the same thing since I'm in radiology...

Ahh, so you are a rad tech that feels you are qualified to comment on "noctors?" And no, we are not commenting on the same thing.

 

[elektroshok]

I'm a radiology resident

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[sarjasy]

I'm a radiology resident

OK. Tip. I can send my film of my patient to India. For cheap. You might think about thinking about "noctors" a little differently. You might reflect on what it means to isolate and insult a significant portion of providers who will be sending you future business.

Secondly, any argument you make about "noctors" being incapable of reading a film (and knowing when to send to rads) due to lack of training can be used against peds/FM/IM and even EM docs, and pretty much anyone that's not a radiologist. Then again, if all doctors are all capable of reading a film accurately, maybe we don't need radiologists for plain films afterall....?

Edit..if you are curious, I can tell you several stories about how the radiologist screwed up a patient eval, as well as two examples of FP colleagues screwing up on films, both of which required my incompetence as a "noctor" to straighten things out and get the patient the care they needed. And do you know how long I've practiced as a "noctor?" 1 year.

 

[sarjasy]

It's like medicine, but you have no idea what you're doing.

I joke, I joke...

Pretty funny. But is that a reference to nurse practitioners or a radiologist in a room with a patient?

 

[Mad Jack]

Pretty funny. But is that a reference to nurse practitioners or a radiologist in a room with a patient?

Both.

 

[PsychMajorUndergrad18]

http://www.nytimes.com/2014/04/30/opinion/nurses-are-not-doctors.html?_r=0

Here's one article that highlights a couple things as to why NPs should not practice medicine.

 

[PsychMajorUndergrad18]

I understand that there is a need for NPs to be in primary care due to the lack of primary care physicians but there seems to be a line that has been crossed when a good amount of NPs refers to themselves as doctors or say that they are practicing medicine.

 

[sarjasy]

Both.

Dude. Don't be a hater.

Radiologists make bank without ever learning how to use their stethoscopes. Don't be jealous. Derms do the same. And they get to wear sweet white overly-starched designer lab coats, get free facial peels, and probably pedicures q 2 weeks all the while spending January in the Caymans with their SPF 30+ sunscreen in their hip pockets while Instagraming their perfect cuticles.

Not everybody matches, man. It's OK.

The rest of the docs spend 8+ years studying the finer points of inductance and electrical propagation through various types of conductive materials while simultaneously spending their Friday nights doing rote memorization of color-by-number charts of the citric acid cycle, while racking up 6 figures + in debt at the state school. And then THERE'S MATCH. They then have to go on to see 30+ patients a day, while being constantly chastised by their GED-having office manager for billing too many level 3's, while spending an inordinate amount of time on the phone with a desk doctor explaining why a patient needs an MRI instead of a CT.

Of course, that color book memorization of the Krebs cycle, quarter-of-a-million-dollars of debt, and the ability to define a blastomere, makes physicians far more adept at treating hyperlipidemia, abdominal pain, and strep than a stupid "noctor" could ever hope for.

It's yeoman's work, and there is pride in that. Don't hate, man.

 

[Mad Jack]

Dude. Don't be a hater.

Radiologists make bank without ever learning how to use their stethoscopes. Don't be jealous. Derms do the same. And they get to wear sweet white overly-starched designer lab coats, get free facial peels, and probably pedicures q 2 weeks all the while spending January in the Caymans with their SPF 30+ sunscreen in their hip pockets while Instagraming their perfect cuticles.

Not everybody matches, man. It's OK.

The rest of the docs spend 8+ years studying the finer points of inductance and electrical propagation through various types of conductive materials while simultaneously spending their Friday nights doing rote memorization of color-by-number charts of the citric acid cycle, while racking up 6 figures + in debt at the state school. And then THERE'S MATCH. And then go on to see 30+ patients a day, while being constantly chastised by their GED-having office manager for billing too many level 3's, while spending an inordinate amount of time on the phone with a desk doctor explaining why a patient needs an MRI instead of a CT.

Of course, that color book memorization of the Krebs cycle, quarter-of-a-million-dollars of debt, and the ability to define a blastomere, makes physicians far more adept at treating hyperlipidemia, abdominal pain, and strep than a stupid "noctor" could ever hope for.

It's yeoman's work, and there is pride in that. Don't hate, man.

Much as with the following-

How do you hide a hundred dollar bill from a radiologist?

You tape it to a patient.

-again, I was joking.

 

[deleted480308]

I understand that there is a need for NPs to be in primary care due to the lack of primary care physicians but there seems to be a line that has been crossed when a good amount of NPs refers to themselves as doctors or say that they are practicing medicine.

There is not a need for independent NPs. There is a need for more physicians.

 

[Makati2008]

Let's get back on track everyone

 

[Therapist4Chnge]

Edit..if you are curious, I can tell you several stories about how the radiologist screwed up a patient eval, as well as two examples of FP colleagues screwing up on films, both of which required my incompetence as a "noctor" to straighten things out and get the patient the care they needed. And do you know how long I've practiced as a "noctor?" 1 year.

The plural of anecdote is….

 

[BSN2014]

Being an APRN is not like practicing medicine. Not even close.

If you want to practice medicine, go to medical school. If you want to become an APRN (which is a mid-level practitioner, not a doctor), then become an APRN.

Just be sure to research all of your options so you have a clear idea of what you're getting yourself into. You don't want to become an APRN and wish you had went to medical school instead, or vice versa.

 

[InfoNerd101]

Being an APRN is not like practicing medicine. Not even close.

If you want to practice medicine, go to medical school. If you want to become an APRN (which is a mid-level practitioner, not a doctor), then become an APRN.

Just be sure to research all of your options so you have a clear idea of what you're getting yourself into. You don't want to become an APRN and wish you had went to medical school instead, or vice versa.

What is the difference aside from obvious educational differences, between an Aprn and a medical doctor. It seems APRN's do the same thing as doctors so what is the difference between scope of practices.

Like a psychiatric Aprn vs a psychiatrist for instance, they both prescribe diagnose and treatment mental illness.

 

[BreathDeep]

What is the difference aside from obvious educational differences, between an Aprn and a medical doctor. It seems APRN's do the same thing as doctors so what is the difference between scope of practices.

Like a psychiatric Aprn vs a psychiatrist for instance, they both prescribe diagnose and treatment mental illness.

The difference in education is the difference. On the one hand you have the person with 4 years of general scientific education, 4 years of exhaustive general medical education, and 4 years of extensive medical practice diagnosing and treating. On the other hand you have the person with 2 years of less rigorous general science education, 2 years of less of less exhaustive scientific medical education, and 2-3 years of less extensive combined medical education/practice diagnosing and treating.

4 + 4 + 4 = 12
2 + 2 +2/3 = 6-7

6-7 < 12. Unless this is an alternate universe where less is more, the difference is obvious.

 

[Mad Jack]

What is the difference aside from obvious educational differences, between an Aprn and a medical doctor. It seems APRN's do the same thing as doctors so what is the difference between scope of practices.

Like a psychiatric Aprn vs a psychiatrist for instance, they both prescribe diagnose and treatment mental illness.

What you can do and what you're competent at doing are two entirely separate things. APRNs have a wide scope of practice, within which most of them are only competent enough to perform limited portions thereof. A physician usually has a pretty wide breadth of competence, and can handle far more things than an APRN within a given field. Hence why basically any APRN will bump the hard stuff to a doctor- they just can't handle the difficult cases because their training is too limited.

 

[sarjasy]

The plural of anecdote is….

...Not evidence.

I doubt you have ever posted that phrase in response to the dozens (if not more) in this forum that show up and post something like, "You won't believe what this NP did..." I'm sure you will the next time, though.

 

[Boatswain2PA]

What is the difference aside from obvious educational differences, between an Aprn and a medical doctor. It seems APRN's do the same thing as doctors so what is the difference between scope of practices.

Like a psychiatric Aprn vs a psychiatrist for instance, they both prescribe diagnose and treatment mental illness.

From a patient's perspective, probably not very much but that's because the patient doesn't understand what is wrong with them, how the system works, or the differences.

I don't work psych, but I'll give you an "EM" example of how the differences between physicians and mid-levels show themselves.

Recent night I had an drunk and somewhat altered guy come into ED after a reported seizure. GCS 15, but "off", ataxic, with a contracted/decorticate right hand. Reports this is normal due to childhood illness. Scanned his head and when I initially looked at CT I about crapped myself cause it was wayyyyyyyyyyyyyyy wrong. Took me a second to look deeper and I saw nothing that looked it would be acute, so this huge and misshapen left ventricle must be chronic.

WTF could cause that?!? I didn't know. Rads reported it as a porencephalic cyst. WTF is that? I didn't know, had to look it up cause this was the first one I had ever seen.

A BC EM Physician learned a lot more about brain anatomy and physiology than I did in school. Furthermore, and more importantly, they did a specific rotation through radiology where they would see hundreds, if not thousands, of scans/x-rays every day, and this gave them an exposure to the "zebra's" that can make the difference between life and death, or sickness and health, for our patients.

I'm not saying every BC EM physician would know the details about porencephalic cysts, and I'm not saying they would have a better outcome treating this patient than I had, but they just KNOW MORE. For most patients, this doesn't matter. For a few patients, it can matter a lot.

 

[pamac]

That's more of a radiology example of how a radiologist told you what was going on. They would do the same for an MD.

 

[Boatswain2PA]

My point was that the BC physician has been through a residency where they got the opportunity to see, discuss, and learn about many of these zebras. Yes, they would likely wait until the radiologist formally called it, but they've seen (many more of the) zebras before in their residency. It helps.

 

[pamac]

I guess my point isn't that physicians don't have a pretty remarkable level of exposure compared to everyone who isn't a physician, just that in the situation you highlighted, I think a physician would look at the same film you did, groan, and wait for the report from the radiologist... just like you did.

 

[Ischemia1032]

If NPs are allowed to interpret radiology, that scares me. The only people I would truly allow to interpret to the fullest extent are radiologist obviously. I know many internal medicine docs who miss tons of stuff on CXRs that a radiologist would easily see, I have seen top neurosurgeons miss a case of stenosis when it was obvious to the radiologist. NPs absolutely should not be allowed to do anyhting more then take the radiology report into account.

P.S., if you send a crappy history to the radiologist, you get crap out.