DNP or Resident

[foreverLaur]

Thus, 8 years at OSU.

Well, the length depends on the length of the undergraduate degree. I know a few people who completed their undergrad in 3 years, thus making it 7 years. If you did full-time PSEOP you could do undergrad in 2 years, thus making it a 6 year program.

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[184013]

...there are also 3 year PharmD accelerated programs vs the standard 4 year....

 

[Therapist4Chnge]

Wow, this has gone way off-topic.

Agreed.

MOD NOTE: Please keep this on topic. Politics has its very own forum, and shouldn't be talked about in here.

 

[Mike64119white]

A lot depends on the individual, as always. We hire people with experience that still have issues, and we hire new grads that had no prior clinical experience that are exceptional.

BTW - Tipps - you're confusing terms. "midlevel practitioners (DNP)" These are not the same thing. A PA is a midlevel practitioner, but they are not nor will they ever be a DNP. And although they'll never admit it, a DNP will still be a midlevel practitioner. Also the DNP concept is a long long way from reality, with only a handful of programs in the country, and most of them online, which gives almost zero credibility or value to the degree.

I am in a DNP program at a major university that is not online. Our clinical experience is rigorous, much more than that of a master's degree NP and it is insulting to be called a mid level practitioner especially when I find myself teaching the medical residents.

 

[Mike64119white]

Here is the problem : 22 states allow NPs to practice independently . There is a push to get more states to grant full independent pratice prviliges to NPs . I have read articles in which the group pushing this nonsense claim that NPS are equal and even better than trained physicians . Its time for the AMA to put a stop to this nonsense .

DNPs are taking over primary care regardless of wether MDs and DOs like it or not, and yes, we are doctors, not PhDs!

 

[Mike64119white]

DNPs are taking over primary care regardless of wether MDs and DOs like it or not, and yes, we are doctors, not PhDs!

the designation DNP is simply a different approach to healthcae. Allopathic physicians believe that disease is the primary focus. DOs claim that the spine is the primary focus. Both philosophies are wrong. DNPs believe that the whole individual is the primary focus!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

 

[foreverLaur]

the designation DNP is simply a different approach to healthcae. Allopathic physicians believe that disease is the primary focus. DOs claim that the spine is the primary focus. Both philosophies are wrong. DNPs believe that the whole individual is the primary focus!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Right. MDs and DOs have been ruining the lives of the patients they see for years. Why haven't we figured this out earlier?!

 

[jwk]

DNPs are taking over primary care regardless of wether MDs and DOs like it or not, and yes, we are doctors, not PhDs!

Why do you indicate that you are an MD/PhD student when you are neither?

 

[jwk]

the designation DNP is simply a different approach to healthcae. Allopathic physicians believe that disease is the primary focus. DOs claim that the spine is the primary focus. Both philosophies are wrong. DNPs believe that the whole individual is the primary focus!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

What an absolutely assinine post.

 

[lapelirroja]

the designation DNP is simply a different approach to healthcae. Allopathic physicians believe that disease is the primary focus. DOs claim that the spine is the primary focus. Both philosophies are wrong. DNPs believe that the whole individual is the primary focus!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I can see clearly now that you are a troll. This is ridiculous.

 

[jwk]

I am in a DNP program at a major university that is not online. Our clinical experience is rigorous, much more than that of a master's degree NP and it is insulting to be called a mid level practitioner especially when I find myself teaching the medical residents.

You may not like it, but you are and will always be a mid-level practitioner unless you become a physician. And just because you may be a DNP someday, you are still not a physician, you're not equivalent in any way, shape, or form to a physician, you will not have an unrestricted license to practice medicine like a physician, and if you call yourself one, you can be prosecuted in a number of states. Be happy with what you are, not what you hope you can fool people into thinking you are by calling yourself doctor, because really, there is no other reason for you to do so.

And explain to me why a DNP student would be teaching medical residents (who are already physicians) anything.

 

[McPoyle]

Maybe she's teaching them how to mislead patients and the public, how feign competence or whatever else this group does.

 

[foreverLaur]

FYI - just talked to the University of Arizona about their BSN-DNP program. It prepares you to be an ACNP, PNP, or FNP and terminates with the DNP (no MSN). It has 74 credit hours and 1,000 clinical hours

 

[fab4fan]

FYI - just talked to the University of Arizona about their BSN-DNP program. It prepares you to be an ACNP, PNP, or FNP and terminates with the DNP (no MSN). It has 74 credit hours and 1,000 clinical hours

Why did you talk to them about it when you are so pro-PA and anti-DNP? Were you just trolling and wasting their time? That's not very professional.

 

[foreverLaur]

Why did you talk to them about it when you are so pro-PA and anti-DNP? Were you just trolling and wasting their time? That's not very professional.

However, I am not anti-NP (via MSN route). I'm keeping my options open in case I am not able to attend school full-time down the road for the PA program. I may have to suck it up and do the DNP if it really does become the entry-level NP degree and I am at a point in my life where PA isn't feasible.

My #1 goal is to become a midlevel provider and provide excellent patient care. I'd prefer to do that via the PA route, but I'd go NP before I'd look for another career.

 

[Therapist4Chnge]

FYI - just talked to the University of Arizona about their BSN-DNP program. It prepares you to be an ACNP, PNP, or FNP and terminates with the DNP (no MSN). It has 74 credit hours and 1,000 clinical hours

Not to nitpick, but 74 credit hours is still not what I'd expect from a "doctoral" level program. Many MS programs are 60, so it is like tacking on a few more classes. Specialist programs are even more than that, though they seem to be less well known.

I really wish if the DNP is going to be pushed through, at least have it be substantial and live up to the expectations of other "doctoral" degree programs.

 

[psychbender]

Not to nitpick, but 74 credit hours is still not what I'd expect from a "doctoral" level program. Many MS programs are 60, so it is like tacking on a few more classes. Specialist programs are even more than that, though they seem to be less well known.

I really wish if the DNP is going to be pushed through, at least have it be substantial and live up to the expectations of other "doctoral" degree programs.

I think that was actually her point.

 

[fab4fan]

However, I am not anti-NP (via MSN route). I'm keeping my options open in case I am not able to attend school full-time down the road for the PA program. I may have to suck it up and do the DNP if it really does become the entry-level NP degree and I am at a point in my life where PA isn't feasible.

My #1 goal is to become a midlevel provider and provide excellent patient care. I'd prefer to do that via the PA route, but I'd go NP before I'd look for another career.

Then that's quite the cute game you've got going there. Perhaps you'd better hold that fire against NPs if your worst fears come true and you have to "suck it up" and go the NP route.

 

[foreverLaur]

Then that's quite the cute game you've got going there. Perhaps you'd better hold that fire against NPs if your worst fears come true and you have to "suck it up" and go the NP route.

I've never had a problem with a NP who function within their role as a midlevel provider, which is majority of the NPs out there.

It is the ones who try to play doctor and the whole DNP thing that I am against. I also prefer the medical model myself, but that doesn't make it better.

I just think that some of the "fluff" could be eliminated and replace with more science courses and/or clinical hours.

 

[DNPDoctor]

I've never had a problem with a NP who function within their role as a midlevel provider, which is majority of the NPs out there.

It is the ones who try to play doctor and the whole DNP thing that I am against. I also prefer the medical model myself, but that doesn't make it better.

I just think that some of the "fluff" could be eliminated and replace with more science courses and/or clinical hours.

Here are the NP courses (the clinical hours here exclude what you receive in post-masters DNP):
http://forums.studentdoctor.net/showpost.php?p=8498973&postcount=25

There are plenty of science courses.
Please don't say that the health promotion & health care courses are fluff.
We can't just be treating diseases.
We should promote health and prevent people from obtaining the disease in the first place.

Here are the BSN courses:
http://forums.studentdoctor.net/showpost.php?p=8507958&postcount=39

 

[foreverLaur]

Here are the NP courses (the clinical hours here exclude what you receive in post-masters DNP):
http://forums.studentdoctor.net/showpost.php?p=8498973&postcount=25

There are plenty of science courses.
Please don't say that the health promotion & health care courses are fluff.
We can't just be treating diseases.
We should promote health and prevent people from obtaining the disease in the first place.

Here are the BSN courses:
http://forums.studentdoctor.net/showpost.php?p=8507958&postcount=39

The program you posted looks better than some of the other ones I have seen.

Case Western has you taking classes in Teaching & Learning, Finance, etc. Things I have no interest in. I'd rather be taking upper level science courses or getting more clinical hours personally.

If I go the NP route, I'll have to pick and choose my program wisely.

IMO, this is my idea of what a midlevel medical provider education should look like: http://www.med.cornell.edu/education/programs/phy_cur_pre.html

 

[DNPDoctor]

The program you posted looks better than some of the other ones I have seen.

Case Western has you taking classes in Teaching & Learning, Finance, etc. Things I have no interest in. I'd rather be taking upper level science courses or getting more clinical hours personally.

If I go the NP route, I'll have to pick and choose my program wisely.

IMO, this is my idea of what a midlevel medical provider education should look like: http://www.med.cornell.edu/education/programs/phy_cur_pre.html

Thank you for the link. I've just checked it out.

You take most of the science courses listed in the site during BSN.
Anatomy, physiology, microbiology, biochemistry, pathophysiology and pharmacology.
You take multiple advanced pathophysiology, pharmacology, advanced diagnosis, assessment, and more during the NP program.

Both PA and NP programs are good routes to take if you wish to be a mid level practitioner.

Best of luck to you in choosing the profession that is right for you.

 

[foreverLaur]

In my future ADN or BSN programs, we have the option of taking the bio, chem, anat, phys, pathophys, etc for science majors and the ones for students to get gen ed credit. I'm opting to take the more advanced versions and I hope that majority of nursing students do.

At OSU, BSN students can take BIO 101 or 113... CHEM 101/102 or CHEM 121/122. The nursing anatomy is ANAT 199 where the premed anatomy is ANAT 200. Most nursing students take EEOB 232 for physiology, but you can also take the premed version of PHYSIOCB 311/312. They can take the basic microbiology (which only requires BIO 101) or they can take the microbiology for science majors.

Beyond anatomy, physiology, gen chem, and microbio, the only other courses they take are human nutrition (science-wise). If the student opted to take the easier version, it would definitely be some simple courses (some of those, I took both versions and there is a definite difference).

I realize not all nursing programs are like this though and I personally am going to opt for the harder route because I feel like it will make me better in the long run.

Maybe the PA programs just list their hard science courses in a more obvious way, where the NP programs sneak them into classes under more subtle titles.

Either way, I agree. Both NPs and PAs are great midlevel practitioners - they wouldn't have both survived this long if they weren't. I just hope that the outliers pushing for the NPs = MDs doesn't win out!

 

[lapelirroja]

In most cases, the science courses taken for BSN students are not the same for science majors/pre-med/pre-pa. This is why there should be MORE or at least the same amount of science in NP programs than in PA/MD/DO but there isn't, and that is a shame.

Every program (PA, MD, DO) encourages clinicians to treat the 'whole' patient--fluff courses aren't needed to "teach" this. If prospective clinicians aren't able to do this intuitively than they have no business being in patient care at all.

 

[RNtoPharmD]

so throw in a few physical exam classes and you are all set. there are physical exam classes in the doctor of pharmacy programs. just saying.

no offense, i personally would never let another nurse practitioner near me. i have had nothing but horrific experiences with various ones as a patient when i was younger until now.

Unlike you, I am pro-NP. Actually, it will my fallback after graduation if residency position is impossible to obtain or if these new schools are destroying the profession by saturating the market with new grads.

However, I agree with you in adding physical assessment skills in PharmD program. If the arguments against pharmacist prescribing is simply the lack of patient assessment and dignosis skills, adding physical assessment courses and a few hundred hours of "direct" patient care under the supervision of midlevels or MD would invalidate this argument. Either this or we can have some sorts of "patient assessment or diagnosis" post-graduate residency for pharmacists interested in limited prescribing authority.

The problem is that there will be some groups of pharmacists and pharmacy students out there that will protest these ideas.
These people get into pharmacy because they want to get away from direct patient care. They have the idea that pharmacy is a "clean" job and they don't want to touch the patients... well...

 

[psychbender]

Unlike you, I am pro-NP. Actually, it will my fallback after graduation if residency position is impossible to obtain or if these new schools are destroying the profession by saturating the market with new grads.

However, I agree with you in adding physical assessment skills in PharmD program. If the arguments against pharmacist prescribing is simply the lack of patient assessment and dignosis skills, adding physical assessment courses and a few hundred hours of "direct" patient care under the supervision of midlevels or MD would invalidate this argument. Either this or we can have some sorts of "patient assessment or diagnosis" post-graduate residency for pharmacists interested in limited prescribing authority.

The problem is that there will be some groups of pharmacists and pharmacy students out there that will protest these ideas.
These people get into pharmacy because they want to get away from direct patient care. They have the idea that pharmacy is a "clean" job and they don't want to touch the patients... well...

So...if you want to be able to assess/examine patients and prescribe drugs, why didn't you become a physician? Why alter the meaning of your profession to fit your goals in life when you can just choose a profession that already meets those goals?

 

[RNtoPharmD]

So...if you want to be able to assess/examine patients and prescribe drugs, why didn't you become a physician? Why alter the meaning of your profession to fit your goals in life when you can just choose a profession that already meets those goals?

If I were younger or the cost and length of medical education is not this high, I would have dropped out and tried to apply to medical school. My overall GPA is only 3.70, which not enough to get into local in-state school. So basically, I am looking at about at least $300,000 of debt from going to private schools without working when I am almost 40. Not everyone is lucky enough to discover that medical education is a reasonable choice when they were young or when they don't have family members or someone that need their helps. Basically, we do not live forever. I think NP or PA routes give these late starters a second chance.


With that much debt and dedication of time and effort, I am asking myself if the only thing I want to do with my life is to become an "MD.". No. In perfect world, I would rather do something else artistic and imaginative. Medicine is getting more structured and routinized because of rules and regulations from insurance. And my personality is not a good match for jobs that is detailed oriented, routinized, or structured. For this reason, medicine still just another "high well-paying but moderately satisfying" job. I feel that the only medical specialty that would fit me is either psychiatry or academia, which may not generate enough income to pay off that $300,000 loan. If I have to stay in healthcare, besides psychology, I think my personality matches teaching and research, which is not worth another 8 years of education. In conclusion, the return of the investment is not too great. I should better of trying to find academic jobs in pharmacy or anything else that would match me. I am saying that I use NP as fallback because I think I will be "more" satisfied with NP position (mental health) than most pharmacist positions.

I am not trying to change the meaning of the profession. I want pharmacists to be in the position where they can fully utilize their knowledge. With the "complete" lack of authority over the medication management, their knowledge will be underutilized. That's why adding some knowledge about diagnosis and treatment through school or post-graduate residency is important so hopefully pharmacists can claim a bit more autonomy over medication management in the future. I think the extended scope of practice will benefit the society at large because of the accessibility of pharmacy stores.

 

[deleted6669]

there already are 5-6 dual pa/pharmd 5 yr programs out there...do a search in the pharm forum, it was discussed a while ago....

 

[RNtoPharmD]

there already are 5-6 dual pa/pharmd 5 yr programs out there...do a search in the pharm forum, it was discussed a while ago....

That's a great combination. I think it will improve the marketibility of pharmd in general. But there's no dual program in my area. However, I already finish a year of school and it is difficult to transfer from one school to another without repeating a course or delaying the graduation. I should just finish the degree and go back for NP/PA.

 

[zenman]

In most cases, the science courses taken for BSN students are not the same for science majors/pre-med/pre-pa. .

I've never had a science class be it zoology, biology or any of my A & P undergrad courses that were just for nurses.

 

[foreverLaur]

I've never had a science class be it zoology, biology or any of my A & P undergrad courses that were just for nurses.

They aren't just for nurses. They have the premed courses, and then they have the general biology/chemistry courses for nonmajors (which at most schools I have seen include nursing students).

OSU does have a separate anatomy course for nurses though.

The basics of human anatomy supplemented by computer-assisted instruction and demonstrations of human material.
Au, Wi, Sp Qtrs. Prereq: Biology 101 or 113; enrollment in pre-nursing, gpa 2.75. Not open to students with credit for 200.

Biology 101 is the non science major or nursing biology. Biology 113 is the premed biology.

 

[fab4fan]

Perhaps you should stop speaking in such global terms, laur. You aren't even a nurse yet. What may be truth for your program may not necessarily apply to the countless programs out there, and you can't possibly Google-search them all and post back about them.

I have to say I've never seen someone with such a craven career plan. NP as a "fallback" career if PA doesn't work out for you? I wouldn't want to advertise that.

 

[lapelirroja]

They aren't just for nurses. They have the premed courses, and then they have the general biology/chemistry courses for nonmajors (which at most schools I have seen include nursing students).

This is what I meant--ie instead of taking a full year of Gen Chem as any pre-med/pre-pa would, its taking a course called "principles of chemistry" or whatever. And certainly no organic, biochem, etc.

 

[foreverLaur]

What may be truth for your program may not necessarily apply to the countless programs out there, and you can't possibly Google-search them all and post back about them.

I was clearly posting about one specific school and never claimed to know anything about other programs. In one post, I did state that this may not be the case for other programs... just the ones in my area.

I also don't think there is anything wrong with making the PA vs NP decision for myself based upon where life has taken me at the time when I need to make that decision. IMO - I'm leaving the decision up to fate.

 

[fab4fan]

I was clearly posting about one specific school and never claimed to know anything about other programs. In one post, I did state that this may not be the case for other programs... just the ones in my area.

I also don't think there is anything wrong with making the PA vs NP decision for myself based upon where life has taken me at the time when I need to make that decision. IMO - I'm leaving the decision up to fate.

Then you may need to rethink all of your anti-NP rhetoric. It makes you look a bit "flighty."

 

[Taurus]

Folks,

This is a perfect example of NP's who don't know what they don't know. Read this posting and some of the responses from allnurses.com.

Hello,
Does anyone know of any clinical circumstance where one would increase a pt's dose of Synthroid for a low TSH? (low, as in, <0.5)
Thanks!
-Kan​

A low TSH can either mean the thyroid hormone levels are too high and are suppressing TSH levels. Increasing synthroid will lead to hyperthyroidism. However, if the pt has Sheehan's Syndrome, the low TSH levels are caused by a pituitary infarction and the thyroid hormone levels are low. Then in this case, the pt requires synthroid.

In any case, the next step for this pt is to measure thyroid hormone levels and not to blindly follow some protocol you got in nursing school for low TSH levels. Use your heads! Open a book and look up some of the causes of low TSH! Freaking amazing.

The general public needs to understand how much risk they are putting themselves by seeing independent NP's. It is truly scary many of the stories I read about.

Physicians have a moral obligation to protect the public. Physicians have a moral obligation to work with trial lawyers to weed out these incompetent "providers".

 

[zenman]

Physicians have a moral obligation to protect the public. Physicians have a moral obligation to work with trial lawyers to weed out these incompetent "providers".

Perhaps, but many physicians continue to practice...

 

[hereiamagain2]

The only nurse practitioner answered thus
"Yes. Patients who have survived thyroid cancer. They are at or near total suppression. "
Guess what that is a correct answer, I can see the need to protect the public from correct clinical knowledge thanks Taurus the world is so much safer with you in it

 

[foreverLaur]

Then you may need to rethink all of your anti-NP rhetoric. It makes you look a bit "flighty."

Again, I am not anti-NP. I am anti-DNP and anti NPs trying to leave the midlevel role and try to work entirely independent from physicians.

 

[bradt9881]

Woops. already answered above....

 

[fab4fan]

Again, I am not anti-NP. I am anti-DNP and anti NPs trying to leave the midlevel role and try to work entirely independent from physicians.

Well, unfortunately, the DNP is going to become the standard somewhere down the road. You may not have a say, depending on when you graduate.

Your post history says otherwise, but if that's what you want to say now, run with it. It wouldn't be the first time you've changed your story.

 

[fab4fan]

Folks,

This is a perfect example of NP's who don't know what they don't know. Read this posting and some of the responses from allnurses.com.

Hello,
Does anyone know of any clinical circumstance where one would increase a pt's dose of Synthroid for a low TSH? (low, as in, <0.5)
Thanks!
-Kan​

A low TSH can either mean the thyroid hormone levels are too high and are suppressing TSH levels. Increasing synthroid will lead to hyperthyroidism. However, if the pt has Sheehan's Syndrome, the low TSH levels are caused by a pituitary infarction and the thyroid hormone levels are low. Then in this case, the pt requires synthroid.

In any case, the next step for this pt is to measure thyroid hormone levels and not to blindly follow some protocol you got in nursing school for low TSH levels. Use your heads! Open a book and look up some of the causes of low TSH! Freaking amazing.

The general public needs to understand how much risk they are putting themselves by seeing independent NP's. It is truly scary many of the stories I read about.

Physicians have a moral obligation to protect the public. Physicians have a moral obligation to work with trial lawyers to weed out these incompetent "providers".

And once again, we could get into a tit-for-tat of posting examples of bad NPs v bad MDs. I've certainly been around long enough to see some questionable stuff--occasionally things I've had to go to the doc and get "clarification." Not everyone is a rocket scientist.

I hope we're not going to go back to all of this Taurus posting anti-NP propaganda. I'm not a fan of NPs either, but that was really tiresome. There are plenty of other threads where he can preach his hate.

 

[pianoman511]

I read the original post and from what the OP in that forum said she was just trying to get an idea of what one would do with a TSH at that level. She didn't have a TT3 or FT4 to look at and she is a student, so I would understand the incomplete understanding of the topic.

That being said, there are other posts in that forum on the DNP topic that I would tend to disagree with. Most of what I seem to get is that most on that forum feel by making NPs independent practitioners they will be able to compete with PCPs and "provide the same service cheaper". Along with that, there is the overwhelming feeling that "more education doesn't make a better provider" and "they have all the skills they need for primary care".

It does tend to bother me more than a little bit knowing that I am spending a great amount of time between medical school and residency to learn treatments AND understand the disease process when there are people who do a heck of a lot less pathophys and clinical time and think they can do my job.

I have no problem with midlevels and I think they are a great asset. I just think that with less education/clinical training requires some oversight. This doesn't mean someone standing over their shoulder, but someone to go to with a complex or mysterious patient. I think that the current system is working pretty well and while I do see primary care moving more towards mainly midlevels with one physician as oversight, I do think that oversight is necessary unless a DNP program proves that there is equivalent education and an equivalent knowledge base (maybe have them take the same licensing exam at least as a component of a study comparing knowledge).

Time and time again there have been studies comparing patient outcomes between NPs and MDs but I think the failure of those studies has been with the complexity of the patients and the fact that the current regulations in most states require oversight. Similar studies have shown higher patient satisfaction with NPs but again the failure of those studies seems to lie with the fact that in most practices the ownership lies with the physician (and therefore his/her income is based on the number of patients they see) and the NP is an employee getting a fixed salary (putting less emphasis on maximizing patient's per day).

 

[chman]

I'm not a doctor, but I did stay at a Holiday Inn Express last night.

 

[zenman]

 

[fab4fan]

Amazing that I can hide for 6 months, and not only is this thread still going, but the exact same conversations are still being repeated.

Are you back? Really?



This day just got a whole lot better! Welcome back!

ETA: Shoot. I should have been wearing my reading glasses. I thought that was a thumb-up, but it looks like a fingers crossed! LOL!

 

[schutzhund]

If I were younger or the cost and length of medical education is not this high, I would have dropped out and tried to apply to medical school. My overall GPA is only 3.70, which not enough to get into local in-state school. So basically, I am looking at about at least $300,000 of debt from going to private schools without working when I am almost 40. Not everyone is lucky enough to discover that medical education is a reasonable choice when they were young or when they don't have family members or someone that need their helps. Basically, we do not live forever. I think NP or PA routes give these late starters a second chance.


With that much debt and dedication of time and effort, I am asking myself if the only thing I want to do with my life is to become an "MD.". No. In perfect world, I would rather do something else artistic and imaginative. Medicine is getting more structured and routinized because of rules and regulations from insurance. And my personality is not a good match for jobs that is detailed oriented, routinized, or structured. For this reason, medicine still just another "high well-paying but moderately satisfying" job. I feel that the only medical specialty that would fit me is either psychiatry or academia, which may not generate enough income to pay off that $300,000 loan. If I have to stay in healthcare, besides psychology, I think my personality matches teaching and research, which is not worth another 8 years of education. In conclusion, the return of the investment is not too great. I should better of trying to find academic jobs in pharmacy or anything else that would match me. I am saying that I use NP as fallback because I think I will be "more" satisfied with NP position (mental health) than most pharmacist positions.

I am not trying to change the meaning of the profession. I want pharmacists to be in the position where they can fully utilize their knowledge. With the "complete" lack of authority over the medication management, their knowledge will be underutilized. That's why adding some knowledge about diagnosis and treatment through school or post-graduate residency is important so hopefully pharmacists can claim a bit more autonomy over medication management in the future. I think the extended scope of practice will benefit the society at large because of the accessibility of pharmacy stores.

So basically, you could not or do not want to take the time to go to medical school so you are going to push for another profession to mold into what you could not or do not want to do (medicine).

 

[Farmer Jane]

Tired! Good to see you!!!

 

[fab4fan]

Yeah, it's been a while. Thankfully the world changes, but SDN doesn't.

Awww! All the nurses are stumbling all over themselves to welcome you back. You should feel honored.

Are you back for good?

 

[NarcolepticRN]

Folks,

This is a perfect example of NP's who don't know what they don't know. Read this posting and some of the responses from allnurses.com.

Hello,
Does anyone know of any clinical circumstance where one would increase a pt's dose of Synthroid for a low TSH? (low, as in, <0.5)
Thanks!
-Kan​

A low TSH can either mean the thyroid hormone levels are too high and are suppressing TSH levels. Increasing synthroid will lead to hyperthyroidism. However, if the pt has Sheehan's Syndrome, the low TSH levels are caused by a pituitary infarction and the thyroid hormone levels are low. Then in this case, the pt requires synthroid.

In any case, the next step for this pt is to measure thyroid hormone levels and not to blindly follow some protocol you got in nursing school for low TSH levels. Use your heads! Open a book and look up some of the causes of low TSH! Freaking amazing.

The general public needs to understand how much risk they are putting themselves by seeing independent NP's. It is truly scary many of the stories I read about.

Physicians have a moral obligation to protect the public. Physicians have a moral obligation to work with trial lawyers to weed out these incompetent "providers".

OMG, wow. I feel like I just travelled through a forum wormhole. NarcolepticRN = Kanzi Monkey. Hello.

So, sorry, what was your point about my TSH question? That I don't know how to read a book? That's silly. Read the thread (you've provided the link already, so that should be easy).

I was not writing orders for or treating this patient. I saw something I hadn't seen before (which, as you know, seeing something is always a bit more real than reading it in a book.) The patient had recently had her synthroid increased, and her most recent TSH was low. No T3/4 had been drawn at that time. This patient's endocrine history was not available to me. I had a lab value and an order to give a drug. I was curious and I asked a question. Give me a break.

I am pretty appalled to find myself--completely out of context--being mocked in this forum.