Current DNP Students Thoughts

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not always, I drive past significantly more economical burritos to get to chipotle

depending on the situation, sometimes "better" is the thing that matters when hiring ancillary staff. If I'm em/fm that's likely pa.....if I'm psych, probably a psych np....

Economics didn't mean cheap.

You could hire a new P
http://theadvocate.com/news/opinion/15544722-128/letters-nurse-practitioners-shouldnt-have-autonomy

Letters: Nurse practitioners shouldn’t have autonomy
ADVOCATE STORY
April 20, 2016; 4:28 p.m.
54 Comments
Most people in Louisiana are unaware of Senate Bill 187. It is the most important health care bill to face the state legislature this year. SB187 addresses the ability of nurse practitioners to diagnose, prescribe and treat patients without the supervision of a medical doctor. If this bill passes, the “doctor” you visit when you’re sick may not be a doctor at all.


I am currently an internal medicine resident and completed my medical degree at the LSU School of Medicine. As medical doctors, my colleagues and I will complete 11 to 15 years of academic and clinical experience before we are allowed to practice unsupervised medicine.


Physicians attend four years of medical school with over 4,000 hours of class time and three to seven years of post-graduation training before we have the privilege of treating patients without oversight. If this bill passes, nurse practitioners can do the same after one or two years of post-graduation training including roughly 700 hours of class time. But why does this matter?

Health care access cannot be our sole goal. While physicians welcome anyone who can provide health care to our communities, we have to ensure both quality and access are delivered to every patient.

Medical students obtain an extensive body of medical knowledge after the first two years, but none would or should practice without supervision.


Even at the end of four intense years of medical school, medical doctors, despite having much more training than a nurse practitioner, recognize that they still do not possess the necessary wisdom and reasoning to care for patients alone.

Only after completing years of post-medical school training under direct supervision are physicians allowed that privilege. Learning to deliver high quality care takes years of dedicated mentoring, observation and study.

Medical education matters. Nurse practitioners are part of our health care network, but they are not medical doctors.


The extra years of schooling and clinical training make a critical difference between the way doctors and nurse practitioners treat disease.

Nurse practitioners rely on programmed formulas to treat patients. Medical doctors recognize the limitations of these formulas and are able to personalize care. There is no reset button in the medical field.

Every situation where we believe ourselves to be more skilled and knowledgeable than we actually are could produce harmful consequences to someone’s parent, grandparent, child or friend.


When a student first enters medical school, he or she recites an oath to do no harm. If my loved ones were sick, I would want a physician to treat them, and that is why I urge everyone to call their state representative and tell them to vote no to nurse practitioner autonomy.

Kevin Liu

resident physician


Baton Rouge
No new information here.

But where are my programmed formulas? I wasn't issued those.

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I recently went to an Urgent Care center on a Saturday night for fever, cough, and general malaise. I asked what type of provider I would be seeing and was told "we have a Nurse Practitioner". I asked if they had anyone who practiced medicine and was told there was just an NP. I got back into my car and called another clinic until I found one that had both an MD and PA working. I saw the PA and felt very comfortable with her diagnosis of acute bronchitis, especially since I had just taken my pulmonology exam in PA school.

Meanwhile a friend went to the first NP-staffed clinic a few weeks later for the same complaint and came away with a negative CXR but a prescription for Zithromax for the same dx (abx for a virus?!). The NP also wanted to get a sputum sample and do a CBC but my friend declined. I've read studies on NPs using more resources than PAs or MDs and this only serves to solidify the higher-cost-of-care that NPs burden the system with. You might pay the NP less than an MD but they utilize more resources in order to make up for their poor clinical skills. The most interesting part is the NP admitted she had no idea how to read a CXR (what?!) and had to wait until the next day for a radiologist read but that he should immediately start the loading dose and following doses of the abx until a call from the clinic. It seems this NP doesn't know about serum trough levels causing bacterial resistance. I'm not expecting NPs to be at the level of neuroradiologists but interpretation of a basic CXR is a basic skills that someone in urgent care needs to have and is something we spend a lot of time on in PA school.

Abx are widely over prescribed by MDs as well. My wife's FP gives her Zithromax for every cough. She fills the script, brings it home, and I put in my study. I have a cabinet full if meds. She gets better a few days later.

Yeah, the CXR " hour" really hacked me off in school. I have a previous rant about this.

Overuse of studies have been a published problem of NPs for at least a decade it seems. When I covered UC as a RN it seemed everyone (md, do, np, pa) ordered tests about equally.

The EM boarded Navy MD was the worst. Anything involving the head went to ED for CT.

It's true, NP school is light weight. Let's keep beating the horse. I hope you feel accomplished. I do because I'm good at my job and make a lot of money.
 
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I recently went to an Urgent Care center on a Saturday night for fever, cough, and general malaise. I asked what type of provider I would be seeing and was told "we have a Nurse Practitioner". I asked if they had anyone who practiced medicine and was told there was just an NP. I got back into my car and called another clinic until I found one that had both an MD and PA working. I saw the PA and felt very comfortable with her diagnosis of acute bronchitis, especially since I had just taken my pulmonology exam in PA school.

Meanwhile a friend went to the first NP-staffed clinic a few weeks later for the same complaint and came away with a negative CXR but a prescription for Zithromax for the same dx (abx for a virus?!). The NP also wanted to get a sputum sample and do a CBC but my friend declined. I've read studies on NPs using more resources than PAs or MDs and this only serves to solidify the higher-cost-of-care that NPs burden the system with. You might pay the NP less than an MD but they utilize more resources in order to make up for their poor clinical skills. The most interesting part is the NP admitted she had no idea how to read a CXR (what?!) and had to wait until the next day for a radiologist read but that he should immediately start the loading dose and following doses of the abx until a call from the clinic. It seems this NP doesn't know about serum trough levels causing bacterial resistance. I'm not expecting NPs to be at the level of neuroradiologists but interpretation of a basic CXR is a basic skills that someone in urgent care needs to have and is something we spend a lot of time on in PA school.

I agree, you went to an unseasoned NP. Was probably good intuition to go somewhere else. Does it prove anything? No. I went to a Physician who prescribed medication that caused a GI bleed who should have known better. Does that mean I refuse to see a Physician again? Nope. I really enjoyed the article you posted, the comments are very interesting as well. The article was a bit intellectually dishonest though; counting physician undergraduate education as medical education and glossing over a nurses undergraduate degree and the clinical hours that go with it.

In reality a physician can practice medicine after completing their intern year only. So you have 8 years for the DNP NP vs 9 years for the MD. Medicare pays a huge percentage of the cost to put a physician through residency. If the government started to pay NPs to attend a residency, I think Physicians would like that a lot less than just letting us be mid-levels and physician extenders seeing primary care patients that have been proven by study after study as safe to treat.
 
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I agree, you went to an unseasoned NP. Was probably good intuition to go somewhere else. Does it prove anything? No. I went to a Physician who prescribed medication that caused a GI bleed who should have known better. Does that mean I refuse to see a Physician again? Nope. I really enjoyed the article you posted, the comments are very interesting as well. The article was a bit intellectually dishonest though; counting physician undergraduate education as medical education and glossing over a nurses undergraduate degree and the clinical hours that go with it.

In reality a physician can practice medicine after completing their intern year only. So you have 8 years for the DNP NP vs 9 years for the MD. Medicare pays a huge percentage of the cost to put a physician through residency. If the government started to pay NPs to attend a residency, I think Physicians would like that a lot less than just letting us be mid-levels and physician extenders seeing primary care patients that have been proven by study after study as safe to treat.

What if Medicare dropped reimbursement across the board so physicians were receiving what we get rather than us being extended to get what docs currently get? Hypothetical scenario but politically charged.
 
Interesting idea. What if our government no longer paid to train foreign doctors who often go back to their own countries to practice? Interesting idea.

I also think when we talk about increasing NP education, Physicians should be careful what they wish for. I haven't gotten to the portion of my medical training, which I'm told won't exist, so I will let everyone know what my content is when I get there and if I am disappointed or not, I'm sure I will be though. Let's say hypothetically we increase the rigor and take out the fluff (btw, the fluff, while not useful in treating patients, is stuff you really should know if you want to call yourself a doctor of nursing, but I digress) and have very intensive medical training with a 2 year government supported residency program at the end. Then the NP's would be taking even MORE jobs from the Physicians, and there would be blood in the streets!
 
Interesting idea. What if our government no longer paid to train foreign doctors who often go back to their own countries to practice? Interesting idea.

I also think when we talk about increasing NP education, Physicians should be careful what they wish for. I haven't gotten to the portion of my medical training, which I'm told won't exist, so I will let everyone know what my content is when I get there and if I am disappointed or not, I'm sure I will be though. Let's say hypothetically we increase the rigor and take out the fluff (btw, the fluff, while not useful in treating patients, is stuff you really should know if you want to call yourself a doctor of nursing, but I digress) and have very intensive medical training with a 2 year government supported residency program at the end. Then the NP's would be taking even MORE jobs from the Physicians, and there would be blood in the streets!
Let's be real. I doubt many NPs are going to be signing up for 80 hour/week residencies.
 
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I would do it in a heart beat. I know how inadequate I will be upon graduation, and I want to do anything possible to be safer for both my patients and myself.
 
I also work with residents and know they don't work 80 hours a week. The ICU is the worst rotation they have at my hospital hours wise and they end up with around 60-65 hours a week.
 
I would do it in a heart beat. I know how inadequate I will be upon graduation, and I want to do anything possible to be safer for both my patients and myself.

So why not go to medical school....


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I also work with residents and know they don't work 80 hours a week. The ICU is the worst rotation they have at my hospital hours wise and they end up with around 60-65 hours a week.

Sounds like a light icu. I bet if you included other academic commitments it would be closer to 80


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A 3 resident team with an onsite intensivist for a 12 bed MRICU. So it's a lot of teaching and learning. It's a very healthy workplace environment. The nurses have very good relationships with the residents and we all kind of learn together. I really enjoy the privilege of working there and learning from everyone.
 
yes, foolish

I should've used quotations. "MY BAD" ----> what I was referring to was that nurses have a very special set of skills of observation and are very quick to notice change. I'm not taking ANYTHING away from MDs and their extensive training (i'm sorry if it sounded like i was trying to discredit them)

Overall, I believe the ignorance of what NPs are and their place as healthcare professionals, is due to the lack of consistency and requirements to obtain such credentials. In turn, making it seem like a Doctor of Nursing practice can be obtained by simply opening a cracker jack box. They go through a lot of academia. One thing I think is the biggest flaw is allowing someone with no RN but a bachelors in ANY field, be allowed into a graduate entry program and in 3-4 years hold a DNP. Even though the courses are rigorous and brutal. I don't feel think it's "respectful" when there are others who've worked their way from the very bottom of the ladder. Not sure if this same sort of things happen in your states, but, it does happen here.
 
Overall, I believe the ignorance of what NPs are and their place as healthcare professionals, is due to the lack of consistency and requirements to obtain such credentials. In turn, making it seem like a Doctor of Nursing practice can be obtained by simply opening a cracker jack box. They go through a lot of academia. One thing I think is the biggest flaw is allowing someone with no RN but a bachelors in ANY field, be allowed into a graduate entry program and in 3-4 years hold a DNP. Even though the courses are rigorous and brutal. I don't feel think it's "respectful" when there are others who've worked their way from the very bottom of the ladder. Not sure if this same sort of things happen in your states, but, it does happen here.
No they aren't!
 
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Prove your statement that no DNP programs have rigor. Otherwise you are trolling.
 
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Prove your statement that no DNP programs have rigor. Otherwise you are trolling.

http://www.chamberlain.edu/admissions/graduate/Doctor-of-Nursing-Practice-Degree/curriculum


Doctor of Nursing Practice (DNP) Curriculum
Chamberlain’s DNP curriculum is grounded in eight essentials outlined in the American Association of Colleges of Nursing document, The Essentials of Doctoral Education for Advanced Nursing Practice (DNP Essentials)1. Input from key constituencies, and several national documents and data are also incorporated into the program. These include, but are not limited to, the Institute of Medicine, Quality and Safety Education for Nurses and other national initiatives focusing on change and transformation to promote patient safety, nurse vitality and quality care outcomes in a culturally diverse society.

The DNP curriculum helps you develop and advance your practice to new levels. As a graduate, you will be prepared to work in leadership roles in a variety of healthcare delivery settings leading patient care services that result in quality improvement and patient safety.

Chamberlain’s DNP Healthcare Systems Leadership specialty track is designed for RNs and APRNs with a master’s degree in nursing, and requires completion of 32 to 40 credit hours and a total of 1000 post-baccalaureate practicum hours. You can expect to complete two courses per semester over a total of six semesters.


The DNP Project & Practicum Experience
Throughout the program, you will put your learning into practice during a project and practicum experience. You will work closely with a practicum coordinator, Chamberlain faculty and your chosen preceptor, an expert in the nursing field who provides guidance throughout the practicum experience.

Chamberlain faculty members provide guidance and support as you determine your project and practicum focus, as well as an appropriate location and preceptor. At the conclusion of your first course you will attend a DNP Project & Practicum orientation session and then will begin the steps that will ultimately lead to your project and practicum experience. This means you do not need to know the focus of your DNP project or your practicum location before you enroll. Upon graduation, you will be prepared to identify, research, design and implement a practice or system change project.


Doctor of Nursing Practice (DNP) Degree Course Descriptions
Download the DNP Curriculum Plan (PDF).

Core DNP Courses
NR-700: Scientific Underpinnings – 3 Credits

NR-701: Application of Analytic Methods – 3 Credits

NR-703: Applied Organizational & Leadership Concepts – 3 Credits

NR-704: Concepts in Population Health Outcomes – 3 Credits

NR-706: Healthcare Informatics & Information Systems – 3 Credits

NR-708: Health Policy – 3 Credits

Healthcare Systems Leadership Specialty Track Courses
NR-702: DNP Project & Practicum I – 3 Credits (Theory .5, Practicum 2.5)

NR-705: DNP Project & Practicum II – 3 Credits (Theory .5, Practicum 2.5)

NR-707: DNP Project & Practicum III – 3 Credits (Theory .5, Practicum 2.5)

NR-709: DNP Project & Practicum IV – 3 Credits (Theory .5, Practicum 2.5)

NR712: Topics in Healthcare Systems Leadership – 3 Credits

NR713: Indirect Care Perspectives in DNP Practice – 3 Credits

Which of these courses you think are challenging?
 
To be fair, that DNP program is designed for nurses with prior Masters degrees. Suggesting that there's "scientific rigor" in the sense that they're learning pharmacology, pathology, etc. doesn't apply. Chamberlain looks like a mini MPH masquerading as a DNP (maybe less stats focused?).

Anyway, if you want to argue physician vs. NP/PA as far as coursework goes, you'd need to look at their (if they have one ) APRN program and compare to a MD/DO curriculum. I don't think anyone would argue that the latter is more rigorous.

I totally agree that physicians are better tasked to cover healthcare delivery issues in their fields on a micro level (patient, ED, ward, etc.); but frankly, we don't get that much training in population studies, epi, etc., relative to Masters level degrees (MPH specifically). I could see this particular program bridging the gap between a mid-level clinician and an MPH or something... but whether that's true of all DNP programs, just this one, etc. is beyond me.

Of course, the idea that these programs aren't on some level "the same" may be the bigger issue.
 
You picked a Healthcare Systems Leadership DNP which is post masters. You did not include the 2 years of masters coursework that is a pre-requisite to this degree. This degree specifically is not clinician based.

None of that matters, however, since posting a plan of study says nothing concerning the actual rigor of the courses. Furthermore, you did nothing to prove that all DNP programs are without rigor.
 
You picked a Healthcare Systems Leadership DNP which is post masters. You did not include the 2 years of masters coursework that is a pre-requisite to this degree. This degree specifically is not clinician based.

None of that matters, however, since posting a plan of study says nothing concerning the actual rigor of the courses. Furthermore, you did nothing to prove that all DNP programs are without rigor.
Why don't you post a DNP curriculum with course description so we can decide how rigorous these courses are... You keep making claim that DNP programs are rigorous, but all the program I looked at have a bunch of fluff classes.
 
If you read the entirety of this thread that's been done. It lead to someone guessing at what is involved in the course work with no evidence to back them up. The statement "no DNP program has rigor," which is what I asked you to prove, is not an argument that can be won, just as always or never statements are foolish, so is the statement "no DNP program has rigor."
 
If you read the entirety of this thread that's been done. It lead to someone guessing at what is involved in the course work with no evidence to back them up. The statement "no DNP program has rigor," which is what I asked you to prove, is not an argument that can be won, just as always or never statements are foolish, so is the statement "no DNP program has rigor."
You started with that rigorous claim; I did not...
 
Juggling chainsaws is rigorous, running an ultramarathon is rigorous, passing a kidney stone is rigorous.

Rigorous doesn't mean anything by itself.....i don't care if your degree is hard, i care if you are the most qualified to diagnose and determine treatment....
 
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Are you trolling? It's been agreed upon by everyone involved in this conversation that NP's are not the "most qualified" to diagnose and treat disease. The question is do they deliver safe care and refer when needed? The answer has been found to be objectively yes. If you find evidenced based peer reviewed research studies showing that NP's are unsafe in their current role I want to read them so that I know how best to treat the patients I will be caring for.
 
Are you trolling? It's been agreed upon by everyone involved in this conversation that NP's are not the "most qualified" to diagnose and treat disease. The question is do they deliver safe care and refer when needed? The answer has been found to be objectively yes. If you find evidenced based peer reviewed research studies showing that NP's are unsafe in their current role I want to read them so that I know how best to treat the patients I will be caring for.
Link the studies that say "objectively yes"
 
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Probably... Pharmacology is whole year course in med school and it's kicking everyone's butt... These people who are attending UW-M are geniuses if they can master pharm in one semester.
Mine was only 1 semester and I went to a fairly unremarkable southern state school.
 
In reality a physician can practice medicine after completing their intern year only. So you have 8 years for the DNP NP vs 9 years for the MD. Medicare pays a huge percentage of the cost to put a physician through residency. If the government started to pay NPs to attend a residency, I think Physicians would like that a lot less than just letting us be mid-levels and physician extenders seeing primary care patients that have been proven by study after study as safe to treat.
OK first, this is only true in some state and usually only for US medical schools. Second, completing only an intern year makes you virtually unemployable. Medicare won't pay you to treat patients without completing a residency.

The studies comparing midlevels to physicians have, one and all, had huge flaws. I'm not saying that y'all are inferior to us for uncomplicated primary care (although I certainly believe that), but none of the studies to date have been compelling.
 
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A 3 resident team with an onsite intensivist for a 12 bed MRICU. So it's a lot of teaching and learning. It's a very healthy workplace environment. The nurses have very good relationships with the residents and we all kind of learn together. I really enjoy the privilege of working there and learning from everyone.
Seriously? I'm family medicine and I covered a larger ICU than that with a single intern during my residency. If that's an IM residency, I'm going to be very disappointed.
 
Here is systematic review of literature conducted in 2002 (when education for NP was much less than today) showing that the evidence proves NPs provide equal health outcomes to physicians, with moderate rigor.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC100791/

Here is a article quoting a second systematic review from 2009 that states "A high level of evidence also indicated that patient outcomes on satisfaction with care, health status, functional status, number of emergency department visits and hospitalizations, blood glucose, blood pressure, and mortality are similar for NPs and MDs."

http://www.medscape.com/viewarticle/810692

I have just linked evidence. I did a literature search concurrently to find systematically reviewed studies showing that NP's do not provide health outcomes similar to physicians. I could not find what I was searching for.

Now you should provide proof, sb247, that NP's do not provide safe care to their patients. If you cannot you are using the fallacy of the shifting burden of proof; i.e. I need not prove my claim, you must prove it false.

Reference:

Horrocks, S., Anderson, E., & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors.BMJ : British Medical Journal,324(7341), 819–823.
 
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Here is systematic review of literature conducted in 2002 (when education for NP was much less than today) showing that the evidence proves NPs provide equal health outcomes to physicians, with moderate rigor.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC100791/

Here is a article quoting a second systematic review from 2009 that states "A high level of evidence also indicated that patient outcomes on satisfaction with care, health status, functional status, number of emergency department visits and hospitalizations, blood glucose, blood pressure, and mortality are similar for NPs and MDs."

http://www.medscape.com/viewarticle/810692

I have just linked evidence. I did a literature search concurrently to find systematically reviewed studies showing that NP's do not provide health outcomes equal to physicians. I could not find what I was searching for.

Now you should provide proof, sb247, that NP's do not provide safe care to their patients.

Reference:

Horrocks, S., Anderson, E., & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors.BMJ : British Medical Journal,324(7341), 819–823.

So without even looking into every study they used in their review, a few things caught my attention.

From your first link: first, 3 authors, none of them physicians. Second, no difference in outcomes despite NPs having longer visits AND doing more "investigations" which is British for "ordering more tests". So this review tells us that if NPs had almost twice as much time per patient and ordered 50% more tests, they came up with the same results as physicians. Not exactly a ringing endorsement of NPs here.

Second study: same issues, not one physician involved in the study. This would be like a bunch of family doctors publishing a study about how to treat diabetes without a single endocrinologist - chance of bias is quite high. Next, unlike in the previous study, tests ordered, referrals to specialists, length of visits, and prescriptions written were not investigate - as I mentioned for study 1, if your outcomes are the same as mine but you spend twice as much time and order 50% more tests then I'm not impressed. Beyond that, many of the studies didn't differentiate between independent NPs and those working under a physician - if you run all your decisions by an MD I would hope you'd have similar outcomes to that same MD. Even further, the quality measures they looked at where things like blood pressure and glucose control NOT things like MIs, CVAs, or PVD. I can use a beta blocker to get great blood pressure control, but it doesn't prevent HTN complications nearly as well as other agents. The one area that NPs did better at (lipid control) it turns out isn't that important - the numbers matter less than the anti-inflammatory effects of statins.

As for us providing proof that NPs provide worse care - such a study is highly unethical and would never make it past an IRB. You can't ever do a study where you think your hypothesis is going to be a WORSE outcomes.
 
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A retrospective study does not require the same IRB rigor and is no danger to the patients. If Physicians ran these studies a high probability exists for bias in the opposite direction. Doctor, respectfully, you are using the fallacy of the shifting burden of proof.
 
The second study is a study conducted by six PhD's and one MD.

"

Systematic reviews are the highest levels of evidence. This one has mentioned that they only took studies of randomized control trials, which are level 2 evidence, the strongest outside of systematic reviews.

"Although all the reviewers were nurses, the investigator team included 2 experts in the evaluation of heath care quality and effectiveness and a physician with extensive experience conducting systematic reviews. Articles included in the review were published in peer-reviewed medical (n = 12),33, 37, 39, 45, 48, 51, 52, 56, 57, 59, 61 and 64 interprofessional (n = 10)34, 36, 38, 43, 46, 47, 49, 53, 55 and 60 and nursing (n = 15) journals.35, 40, 41, 42, 44, 50, 54, 58, 62, 63, 65, 66, 67, 68 and 69 A draft of the report was reviewed by 2 independent panels of technical experts: 1 panel comprised a consumer, a statistician, and a physician leader; the other included highly respected NPs. Written comments and recommendations from these reviewers were addressed by the authors."

The question is if NP's deliver safe care to their patients. The answer from this article is a resounding yes. The article is sound scientifically and states in the conclusion section "Multiple policy implications can be drawn from these results.70 The evidence identified in this review supports the premise that outcomes of NP-provided care are equivalent to those of physicians. Thus the question of the comparability of NP/MD quality, safety, and effectiveness of care is answered, to a very considerable degree, by this review."

If your question is can NP's acheive comparable outcomes without the collaboration of an MD, that question is still on the table for discussion. The question of whether NP's can safely care for patients, however, has been answered.
 
A retrospective study does not require the same IRB rigor and is no danger to the patients. If Physicians ran these studies a high probability exists for bias in the opposite direction. Doctor, respectfully, you are using the fallacy of the shifting burden of proof.
And retrospective studies suck, there's a reason we rarely change clinical practice based on them.

You're correct about physician bias as well which is why I'd expect to see a study with decent numbers of both.

Its not shifting burden of proof at all. I've written on this subject at length here on SDN (though admittedly not in the last few years) and my argument is always the same. I want similar outcomes (not surrogate measures) with similar efficiency and resource utilization and a distinction made between independent NPs and supervised NPs. Do all that, and I'll jump behind NPs 100%.
 
I agree Doctor, more evidence needs to be collected, but the current evidence does justify the NP's position as a safe alternative to MD's as long as a collaborative agreement is in place. Thank you for the discussion.
 
I agree Doctor, more evidence needs to be collected, but the current evidence does justify the NP's position as a safe alternative to MD's as long as a collaborative agreement is in place. Thank you for the discussion.
So we agree that there isn't good evidence for NP independent practice?
 
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I never once mentioned independent NP practice in any post I've ever made.

You, sb247, were challenged to prove your opinion with fact, which you either are evading or unable to do. The very premise of the discussion involved the fallacy of begging the question. The idea that NP's are not safe treating patients because it has not yet been proven yet is the fallacy of the argument from ignorance or the argument from personal incredulity, whichever you want to choose.

Again, sb247, show me evidence that NP's working with a collaborative agreement with MD/DO's do not deliver safe care.
 
I never once mentioned independent NP practice in any post I've ever made.

You, sb247, were challenged to prove your opinion with fact, which you either are evading or unable to do. The very premise of the discussion involved the fallacy of begging the question. The idea that NP's are not safe treating patients because it has not yet been proven yet is the fallacy of the argument from ignorance or the argument from personal incredulity, whichever you want to choose.

Again, sb247, show me evidence that NP's working with a collaborative agreement with MD/DO's do not deliver safe care.
Supervised NPs aren't really delivering the care. The physician is...
 
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I might trust the practice of an NP if everything they did was countersigned and approved by a PA or physician.

There is no reason for a PA to play that role unless it was for a Nurse Practitioner student. Be careful putting down the NPs because there are PLENTY of folks that question our training.


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What's wrong in saying that NP are low-level?

It's an insult to that profession since it was a play on words. PA/NP are known collectively as midlevels or APPs among other things.


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PAs may be midlevel but NPs are lowlevel.

It doesn't matter what you think, it matters what you can prove. Despite your opinion NP outcomes are comparable to MD. A recent study from 2013 reviewed 37 level 2 studies with 5 of the studies from autonomous NP practice. The results stated "Although all the reviewers were nurses, the investigator team included 2 experts in the evaluation of heath care quality and effectiveness and a physician with extensive experience conducting systematic reviews. Articles included in the review were published in peer-reviewed medical (n = 12),33, 37, 39, 45, 48, 51, 52, 56, 57, 59, 61 and 64 interprofessional (n = 10)34, 36, 38, 43, 46, 47, 49, 53, 55 and 60 and nursing (n = 15) journals.35, 40, 41, 42, 44, 50, 54, 58, 62, 63, 65, 66, 67, 68 and 69 A draft of the report was reviewed by 2 independent panels of technical experts: 1 panel comprised a consumer, a statistician, and a physician leader; the other included highly respected NPs. Written comments and recommendations from these reviewers were addressed by the authors."

The results summarized "Multiple policy implications can be drawn from these results.70 The evidence identified in this review supports the premise that outcomes of NP-provided care are equivalent to those of physicians. Thus the question of the comparability of NP/MD quality, safety, and effectiveness of care is answered, to a very considerable degree, by this review."

I will continue providing fact, and you can continue hurling insults. Who sounds like the professional here?

Reference:

Stanik-Hutt, J., Newhouse, R., White, K., Johantgen, M., Zangaro, G., Fountain, L., & Steinwachs, D. (2013, September). The Quality and Effectiveness of Care Provided by Nurse Practitioners. The Journal of Nurse Practitioners, 9(8), 492-500. doi:hungover:oi:10.1016/j.nurpra.2013.07.004
 
No they aren't!

MAYBE IN YOUR STATE IT ISN'T! But, if you enter into a "graduate entry" program here in HAWAII with NO PRIOR RN DEGREE OR EXPERIENCE, they cram EVERYTHING in 3 years. From your science PRE-REQS, clinical hours for completion of Certificate to sit for NCLEX-PN THEN, more clinical hours and training to sit for the NCLEX-RN THEN, all the additional material so you can obtain a DNP! IT IS BRUTAL if you've never had to do any other kind of science classes or nursing classes! I think you misread my post! READ AND COMPREHEND WHAT I WRITE BEFORE YOU REPLY!
 
Why don't you post a DNP curriculum with course description so we can decide how rigorous these courses are... You keep making claim that DNP programs are rigorous, but all the program I looked at have a bunch of fluff classes.

Are you aware that some DNP programs ACCEPT students that have Bachelor degrees in another field UNRELATED to NURSING AND/OR MEDICINE? The program in Hawaii is one of them, which I commented that if anyone dare enter the program with no prior experience or knowing of a closely related field, you're in for a surprise because IT IS RIGOROUS for 3 years that you need to "catch up"....
 
There's every reason for a PA to supervise the practice of an NP as PAs are actually trained for the practice of medicine while NPs are not. NPs are woefully lacking in both didactic and clinical training. Only through the efforts of their political lobbies have NPs been able to force their way into the medical field.

OUCH MAN! I think NPs are great. I will stick by my word when I say that NPs are looked down upon because of the inconsistency in academia and online programs that make the degree look generic. Because the practice of DNPs vary so greatly across the nation, the NP profession is voided by many. Truthfully, would you be able to say that if DNP programs across the nation were more consistent and required more clinical training you'd still be auti-NP? I doubt it. I think "book work" in DNP programs should be kept to a minimum and intensify the clinical training more. I personally am pre-med but am an aspiring MD. Do I feel that NPs would take away my hopes of becoming a Family Practice Dr? Sure I do. But, I respect the NPs philosophy and approach. I'll have to work with some one day and to be quite honest, I didn't know that the person I saw for my physical was an NP! Would've never known! I saw her name tag and felt happy for her! She's holding her own and she seems very well trained to me
 
It doesn't matter what you think, it matters what you can prove. Despite your opinion NP outcomes are comparable to MD. A recent study from 2013 reviewed 37 level 2 studies with 5 of the studies from autonomous NP practice. The results stated "Although all the reviewers were nurses, the investigator team included 2 experts in the evaluation of heath care quality and effectiveness and a physician with extensive experience conducting systematic reviews. Articles included in the review were published in peer-reviewed medical (n = 12),33, 37, 39, 45, 48, 51, 52, 56, 57, 59, 61 and 64 interprofessional (n = 10)34, 36, 38, 43, 46, 47, 49, 53, 55 and 60 and nursing (n = 15) journals.35, 40, 41, 42, 44, 50, 54, 58, 62, 63, 65, 66, 67, 68 and 69 A draft of the report was reviewed by 2 independent panels of technical experts: 1 panel comprised a consumer, a statistician, and a physician leader; the other included highly respected NPs. Written comments and recommendations from these reviewers were addressed by the authors."

The results summarized "Multiple policy implications can be drawn from these results.70 The evidence identified in this review supports the premise that outcomes of NP-provided care are equivalent to those of physicians. Thus the question of the comparability of NP/MD quality, safety, and effectiveness of care is answered, to a very considerable degree, by this review."

I will continue providing fact, and you can continue hurling insults. Who sounds like the professional here?

Reference:

Stanik-Hutt, J., Newhouse, R., White, K., Johantgen, M., Zangaro, G., Fountain, L., & Steinwachs, D. (2013, September). The Quality and Effectiveness of Care Provided by Nurse Practitioners. The Journal of Nurse Practitioners, 9(8), 492-500. doi:hungover:oi:10.1016/j.nurpra.2013.07.004
you can't use supervised NPs being directed by physicians as evidence that NPs can operate at the same level without physician supervision.....
 
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you can't use supervised NPs being directed by physicians as evidence that NPs can operate at the same level without physician supervision.....

You are like a broken record. That was never brought up. If NP's. supervised, have equal outcomes to PA's, then how can you call one a low level and one a mid level? BTW midlevel is a DEA term to differentiate anyone who prescribes medication but it not a physician. APN = Advanced Practice Nurse. See, it says advanced right there.
 
Are you aware that some DNP programs ACCEPT students that have Bachelor degrees in another field UNRELATED to NURSING AND/OR MEDICINE? The program in Hawaii is one of them, which I commented that if anyone dare enter the program with no prior experience or knowing of a closely related field, you're in for a surprise because IT IS RIGOROUS for 3 years that you need to "catch up"....
I am aware of that since I was (am) a nurse... That does not make these programs any more challenging since most of them are loaded with a bunch nursing theory BS...
 
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You are like a broken record. That was never brought up. If NP's. supervised, have equal outcomes to PA's, then how can you call one a low level and one a mid level? BTW midlevel is a DEA term to differentiate anyone who prescribes medication but it not a physician. APN = Advanced Practice Nurse. See, it says advanced right there.

It wasn't me that use the "lowmidelevel" line.

I'm just saying NPs are not equivalent to physicians and shouldn't be independent. You said....

It doesn't matter what you think, it matters what you can prove. Despite your opinion NP outcomes are comparable to MD.

....and it's not true. The study you linked relies on NPs who are supervised by physicians. That means it doesn't work as evidence for, and once again your words here, "NP outcomes are comparable to MD".
 
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