DNP or Resident

[Taurus]

That helps, as I was getting the impression that entire DNP programs were online. What is defined as extensive in your world? If 50% have an online component, you could be suggesting only one course all the way to 100%. Clearly, one/two online courses would be reasonable where 50% or more is of significant concern, and if clinical and other core were online would be more than a significant concern.

That is why I feel that anybody hiring an NP/DNP should ask,

How much of your training was online?

I sure don't want to spend a year training someone on the basics such as how to do a decent H&P, physical exam, what to order, etc when I expect their school should have. It's a waste of my time and money.

Instead of creating a worthless "doctorate" for themselves which no one will recognize as such, nursing would have been better served by emulating the PA education, ie, increasing their admission criteria, standardizing their curricula (eliminate online fluff), and increasing clinical training.

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[mig26x]

Wow, this website is kind of... lame. Only extremely vague snippets of the findings are provided, with no link to an actual article or even a full abstract for many of the studies. I searched for studies with the keyword "online" and there are about thirty articles total.

The first one measures course withdrawal rates, the next one seems to involve a community college and is not clear about what it is actually measuring and has no link to more detailed info, the third one studies "student persistence" in online business statistics courses, the next one appears to use a sample size of exactly one professor for the online group, next there's the study comparing final grades achieved in an English course (with apparently no investigation into any differences in rigor and difficulty between sections, but it's hard to tell because again there's no link to any details)... and that's when I stopped reading.

Scrolling through the rest of the studies it's apparent that some of them are repeats and most, if not all, are studying some facet of student performance in very basic undergraduate level courses. And the quality of the research methods and statistical analysis for most of them looks pretty worthless. One of the "studies" is actually relying very inappropiately on a chi-square analysis for its conclusions. Good grief. With an undergraduate dual major in mathematics and statistics, a graduate degree in education, and several years of experience teaching both high school and college level mathematics in a former life I have quite a bit of experience analyzing "research" like this, and, uh... this is mostly crap. Clearly this website has an agenda, namely reinforcing the conclusions found in whatever 2001 book it's pimping out.

It's interesting reading but I don't think any of it is really applicable this subject. Do you have any research examining what really matters here- the ultimate content mastery and clinical competence in practice of healthcare providers who have completed the majority of their professional/graduate coursework online versus in residence? I have an open mind on this and would be interested in reading any such research, but that link you provided yields nothing of real substance here.

I agree with your entire post, and remember that the website was created by someone who wrote a book about online courses!! Hummm.

 

[WestcoastMedicine]

http://www.medscape.com/viewarticle/514544

 

[foreverLaur]

Hey don't include PAs in thise conversation. PAs aren't trying to act as a physician. NPs are with the DNP.

 

[zenman]

It's interesting reading but I don't think any of it is really applicable this subject. Do you have any research examining what really matters here- the ultimate content mastery and clinical competence in practice of healthcare providers who have completed the majority of their professional/graduate coursework online versus in residence? I have an open mind on this and would be interested in reading any such research, but that link you provided yields nothing of real substance here.

I doubt there is yet any studies comparing say NP performance among online vs traditional education. However, if you want studies on "education" by the people who study education, you can put "distance education research" in google and find plenty of studies and peer-reviewed journals.

As a person who has done both traditional and distance education, in an NP program, I much prefer the distance education. But, I can understand some people preferring to write on a yellow legal tablet vs using a PC. Think about how much extra time I get to review material/study vs someone who has to drive to class, find parking, waste gas, etc.. Plus, if you're sitting in class you get to hear it once. If you have the video, you can listen to a lecture over and over and each time probably pick up something you missed.

It's also amazing to me that either of the schools I've been to, UAB and Rush in Chicago, would automatically drop their good standing in educational circles by offering a sub par delivery system.

So, it basically this: there are excellent traditional and distance education programs and there are not so good ones. There are excellent teachers and sorry ones in both types. There are excellent graduates and sorry ones from both programs.

I can understand you wanting research that compares a group of say, NPs from both type of programs, but good luck in designing it.

 

[zenman]

Everyone should be respected as a person and as a professional in their occuption.

However, to say that RN/NP/PA know more or can replace a MD is ignorant and biased and a sign of inferior complex at best.

Physicians go to medical school and do residency for a reason. If you could be a doctor by just working, heck where was that opportunity when i was a student?!!

Come on, this thread is laughable at best. I'm surprised it hasn't been shut down yet.

Anyway, I love RN/NP/PA for what they do. Simple as that.

Good post, but to be nit-picky (since I have time today), even physicians can be replaced sometimes, say by a Special Forces medic, for one example. If you were in my area and got run over by a rickshaw and had a pneumothorax, I'd pull out my knife, stick a piece of wood in your mouth, stab you, poke a pen barrel in you, cut off a rubber glove finger tip and tie it on to the pen barrel. Would that technically be replacing a physician?

 

[zenman]

Hey don't include PAs in thise conversation. PAs aren't trying to act as a physician. NPs are with the DNP.

Now be careful about generalizations...some PAs do. Most NPs, myself included, think the DNP is not needed...or should at least have much more clinical. I'd even like more clinical in NP programs.

 

[foreverLaur]

Well I meant more so that there is a huge push for NPs to be a DNP by 2015 and basically practice as a physician. There is not that push for PAs (yet, and hopefully never).

 

[foreverLaur]

So under-served areas can have some sort of healthcare professional? I dont mind that but let's keep the titles to the title-holders.

I'm not sure what you are getting at here?

 

[nebrfan]

DNPs are nurses, not physicians; just as PharmDs are pharmacists, not physicians; PsyDs are psychologists, not physicians; and DDSs are dentists, not physicians - but all are doctors. the AMA claim of "patient confusion" is bogus and sadly we have seen this game before (optometrists and osteopaths jump to mind).

But, when talking to a PharmD behind the counter, it is reasonable to assume the patient knows they are at a pharmacy, talking to a pharmacist. When at the dentist (note the vernacular - people don't say they are going to see the 'doctor' when going to see a DDS) it is reasonable to assume the patient knows they are seeing a dentist. When going to do the 'better one or better two?' thing - patients know the optometrist (the 'eye doctor') is different from their 'doctor' - same with laying on a couch to talk to a psychologist - which is why in many states they have to go to their doctor to get scripts filled. However, when going to a general clinic to talk about medical health issues - and someone walks in and says "I'm Dr. X" the reasonable assumption is they are a MD.

...as would opportunity to sit for the USMLE 3 exam

Pathologists have to pass step 3 - as well as steps 1 and 2 ... but would you feel comfortable allowing a pathologist to independently function as your PCP?

 

[Dr.Millisevert]

When at the dentist (note the vernacular - people don't say they are going to see the 'doctor' when going to see a DDS) it is reasonable to assume the patient knows they are seeing a dentist. When going to do the 'better one or better two?' thing - patients know the optometrist (the 'eye doctor') is different from their 'doctor'

Yeah, but a dentist is the highest level of oral health professional you can see. A nurse is not the highest level of medical personnel. This is not a good analogy. A better analogy would be if dental hygienists were completing a DDH (doctor of dental hygiene) and were trying to replace dentists.

You can't compare patients seeing a Nurse with a "fluff" doctorate to patients seeing a Dentist. It doesn't work.

 

[Dr.Millisevert]

Pathologists have to pass step 3 - as well as steps 1 and 2 ... but would you feel comfortable allowing a pathologist to independently function as your PCP?

Compared to a medically qualified Family doctor. No.

Compared to a nurse ... Yeah. probably so.

 

[nebrfan]

Yeah, but a dentist is the highest level of oral health professional you can see. A nurse is not the highest level of medical personnel. This is not a good analogy. A better analogy would be if dental hygienists were completing a DDH (doctor of dental hygiene) and were trying to replace dentists.

You can't compare patients seeing a Nurse with a "fluff" doctorate to patients seeing a Dentist. It doesn't work.

I agree with you entirely - I was more talking about the argument that patient confusion doesn't exist when talking about DNPs and the use of the word "doctor" - I wasn't comparing a DDS to a DNP ...just that an average patient should be able to tell the difference between a dentist and physician - but probably wouldn't be able to (at least on first glance) between a doctor nurse (which they will claim is the highest level nursing professional you could see ) and a physician - confusion will exist (why else would they add "Dr." to their name but to give a distorted image of their qualifications?) - and i believe a nurse operating in a medical clinic calling him/herself Doctor is guilty of deception of the patient.

 

[Therapist4Chnge]

.....if you want studies on "education" by the people who study education, you can put "distance education research" in google and find plenty of studies and peer-reviewed journals.

Unfortunately it is like doing pharma research and accepting big $$ from the pharma companies....much of the "research" is coming from colleges and universities that not only have online education options, but are often trying to increase them.

 

[237696]

Unfortunately it is like doing pharma research and accepting big $$ from the pharma companies....much of the "research" is coming from colleges and universities that not only have online education options, but are often trying to increase them.

You beat me to saying this. I have been involved in education research during graduate school and I have also actually been involved in administering online instruction both in the public school district where I taught and the community college where I moonlighted. So, yes, I have a very good grasp already on the kinds of educational outcomes-based research out there related to online instruction and your characterization is pretty much the rule.

Further, even if we did accept some of this shoddy and questionable research as reliable and valid, it takes another leap to assume such findings are generalizeable to the type of education we are discussing here (graduate preparation of healthcare clinicians) which is a very different educational genre from basic undergraduate English or math classes.

 

[237696]

I agree with you entirely - I was more talking about the argument that patient confusion doesn't exist when talking about DNPs and the use of the word "doctor" - I wasn't comparing a DDS to a DNP ...just that an average patient should be able to tell the difference between a dentist and physician - but probably wouldn't be able to (at least on first glance) between a doctor nurse (which they will claim is the highest level nursing professional you could see ) and a physician - confusion will exist (why else would they add "Dr." to their name but to give a distorted image of their qualifications?) - and i believe a nurse operating in a medical clinic calling him/herself Doctor is guilty of deception of the patient.

I think you are exactly correct. The nursing advocacy groups who claim that pharmacists, dentists, podiatrists, etc. who use the title "Dr." aren't confusing patients and so it is certain that DNPs using "Dr." won't mislead any patients either are being very disingenous. One knows the difference between a physician and a dentist because they see the dentist in the context of a dental office while receiving dental care. They see the pharmacist (although I've never actually known a PharmD who goes professionally by "Dr.") at the pharmacy counter and they see the optometrist, usually, for refraction.

In an outpatient medical clinic or an inpatient hospital setting, the person in the white coat who breezes into your room, introduces themself as "Dr." and proceeds to examine you and prescribe treatment has always been a physician. That is the physician context. There is too much overlap between the proposed role of the DNP and the role of the physician for there not to be confusion. I personally do not believe the DNP in its present form represents a "true" doctorate, but assuming for a moment that an NP has achieved an actual doctorate (maybe the PhD in nursing), then I do think they should be allowed to use that title in pratice if they choose. However, I also think they should be required to immediately clarify their credential to the patient by identifying themselves as a nurse or nurse practitioner. Some people might not care if it is a physician or an NP treating them, but some do and they have the right to know who exactly is caring for them.

By the way, I also suspect most good NPs already do this and would gladly continue to do so even upon earning a DNP anyway.

 

[Therapist4Chnge]

I also think they should be required to immediately clarify their credential to the patient by identifying themselves as a nurse or nurse practitioner. Some people might not care if it is a physician or an NP treating them, but some do and they have the right to know who exactly is caring for them.

By the way, I also suspect most good NPs already do this and would gladly continue to do so even upon earning a DNP anyway.

I think it is our responsibility as professionals to identify ourselves to the pt: "Hello [pt name]. I am Dr. [name], [job title]." etc. Often times there are issues (cog./visual/auditory impairment), so it is helpful to be proactive.

 

[Dr.Millisevert]

The nursing advocacy groups who claim that pharmacists, dentists, podiatrists, etc. who use the title "Dr." aren't confusing patients and so it is certain that DNPs using "Dr." won't mislead any patients either are being very disingenous. One knows the difference between a physician and a dentist because they see the dentist in the context of a dental office while receiving dental care. They see the pharmacist (although I've never actually known a PharmD who goes professionally by "Dr.") at the pharmacy counter and they see the optometrist, usually, for refraction.

In an outpatient medical clinic or an inpatient hospital setting, the person in the white coat who breezes into your room, introduces themself as "Dr." and proceeds to examine you and prescribe treatment has always been a physician. That is the physician context. There is too much overlap between the proposed role of the DNP and the role of the physician for there not to be confusion.

Much agreed!

 

[fab4fan]

Well I meant more so that there is a huge push for NPs to be a DNP by 2015 and basically practice as a physician. There is not that push for PAs (yet, and hopefully never).

Never mind. I keep erasing what I'd like to say.

 

[zenman]

Unfortunately it is like doing pharma research and accepting big $$ from the pharma companies....much of the "research" is coming from colleges and universities that not only have online education options, but are often trying to increase them.

This seems to be the norm for most all research...yet we pay some attention to it.

 

[foreverLaur]

Am I wrong? Is the DNP not supposed to take over by 2015? Or, is there a push for PAs to have doctorate degrees too?

 

[184013]

when you say, "the DNP will take over by 2015" what exactly are you saying.....?

 

[deleted6669]

when you say, "the DNP will take over by 2015" what exactly are you saying.....?

np/cnm/crna programs will all grant a dnp by 2015. those without will be grandfathered and be able to continue working but all new grads after that time will get the dnp.

 

[core0]

np/cnm/crna programs will all grant a dnp by 2015. those without will be grandfathered and be able to continue working but all new grads after that time will get the dnp.

CRNA date is 2025. This is also suggested. Unlike the Medicare funding issue with the Masters there is no current mechanism to force schools to go to the DNP.

David Carpenter, PA-C

 

[foreverLaur]

I would be surprised if the required minimum for graduating NPs became a doctorate by 2015.

 

[DCWVU]

Blanket statements are hard to make. I've met several fellow residents I wouldn't trust my goldfish to, but some of the best practitioners who the patients loved and I liked working with are NPs and PAs. They've got themselves a really good deal going, IMHO. If i had to do it all over again, I might've went that way. Had I only known!!

 

[prairiedog]

Blanket statements are hard to make. I've met several fellow residents I wouldn't trust my goldfish to, but some of the best practitioners who the patients loved and I liked working with are NPs and PAs. They've got themselves a really good deal going, IMHO. If i had to do it all over again, I might've went that way. Had I only known!!

Agreed, there is no degree or license that will ensure competency. Although I would suggest, the higher educated provider has a better opportunity to be the superior provider.
On another note, white coats do not reflect a MD as suggested in a previous post. Patients will refer to virtually any body in a white coat who walks into their room as their "doctor". Even when the individuals’ introduction clearly states degree(PA/Pharm D). Patients don't care if it is a MD, PA, Pharm D or other, they want to feel better. If the Pharm D is in the room managing coagulation parameters do you really think the patient is thinking pharmacist?

 

[mig26x]

Agreed, there is no degree or license that will ensure competency. Although I would suggest, the higher educated provider has a better opportunity to be the superior provider.
On another note, white coats do not reflect a MD as suggested in a previous post. Patients will refer to virtually any body in a white coat who walks into their room as their "doctor". Even when the individuals’ introduction clearly states degree(PA/Pharm D). Patients don't care if it is a MD, PA, Pharm D or other, they want to feel better. If the Pharm D is in the room managing coagulation parameters do you really think the patient is thinking pharmacist?

that's why i stopped using a white coat.

 

[Darklord]

I've seen some nurses do stupid things and I've seen nurses do not so stupid things.

Anyway, have you heard of the Pharmacist Clinician? It's a basically a pharmacist with a DEA number, who is able to prescribe. From what I know of there are a few PhCs practicing pain management medicine. I believe they were created in one of the Carolinas and in NM. However, I don't they can order any tests or x-rays.

Honestly, though I would go to PhC over a NP.

Rock on Pharmacy!

 

[zenman]

Just because patients like them or you enjoy working with them doesn't make them a [good]physician.

Mid-levels are not physicians, never will be, most don't want to be. So, what are you trying to say?

I know you mean well and are trying to see both sides and being diplomatic, but by saying what you are saying, you're undermining and devaluing all the work a MD put into schooling and residency.[/QUOTE]

No he's not. He's just stating a fact. How does that devalue a physicians schooling?

 

[zenman]

Originally Posted by DCWVU
Blanket statements are hard to make. I've met several fellow residents I wouldn't trust my goldfish to, but some of the best practitioners who the patients loved and I liked working with are NPs and PAs. They've got themselves a really good deal going, IMHO. If i had to do it all over again, I might've went that way. Had I only known!!

SDN9876 There may be some docs you dont trust. I wouldn't trust ANY non-doc. Just because patients like them or you enjoy working with them doesn't make them a [good]physician.

"Any non-doc" includes all mid levels. So, you're saying you wouldn't trust any of them? None of them are intended to be physicians. Some, but not all DNPs might harbor fantasies.

SDN9876 I know you mean well and are trying to see both sides and being diplomatic, but by saying what you are saying, you're undermining and devaluing all the work a MD put into schooling and residency.

I don't see how DCWVU's statement would devalue anything.

 

[foreverLaur]

There may be some docs you dont trust. I wouldn't trust ANY non-doc.

Mid-levels can be excellent care providers when working within their job description and training. My gynecologist is an NP and she is great. I have also been treated by a PA before and he was also great. I have no problems with it as long as they don't try to extend their responsibilities into the realm of physicians.

 

[lapelirroja]

Um, I don't think you know what a PA or NP is. They don't follow orders from physicians, nurses do. PAs and NPs DO make medical decisions, even life or death ones!

Please read about the professions and their training before you comment on midlevel clinicians...it's really quite offensive!

 

[Dimoak]

They don't follow orders from physicians, nurses do. PAs and NPs DO make medical decisions, even life or death ones!

Independent decisions? Without physician supervision and approval? If you think PAs and NPs do not follow orders from physicians, you're being delusional.

 

[foreverLaur]

Independent decisions? Without physician supervision and approval? If you think PAs and NPs do not follow orders from physicians, you're being delusional.

The point was that nurses work under physicians while PAs and NPs work with physicians. PAs and NPs have the right to make diagnostic decisions, order tests, write prescriptions, etc. PAs even have independent practice right (essentially) in some states.... they can run their own practice (basically).

 

[silas2642]

Um, I don't think you know what a PA or NP is. They don't follow orders from physicians, nurses do. PAs and NPs DO make medical decisions, even life or death ones!

Please read about the professions and their training before you comment on midlevel clinicians...it's really quite offensive!

I do agree that midlevels can and do make medical decisions, but they also take orders from physicians-- i.e., "please write up the d/c orders for Mr. Smith, please make sure that his labs are followed up on... etc."

The entire concept of a PA is to help a physician-- Physician ASSISTANT-- no?

 

[core0]

I do agree that midlevels can and do make medical decisions, but they also take orders from physicians-- i.e., "please write up the d/c orders for Mr. Smith, please make sure that his labs are followed up on... etc."

The entire concept of a PA is to help a physician-- Physician ASSISTANT-- no?

Actually the entire concept is to help the patient by providing increased access to care. There are many ways to skin this cat from strictly directed care to a provider that works autonomously with input from the physician as needed.

As for your example, when a physician hands off a patient to another physician saying for them to follow up on the labs are they ordering the other physician? No, they are assuring continuity of care. Similarly I have never been told to write up D/C orders. Instead it is understood that when the decision to D/C the patient is made (by myself or the physician) it is understood that its my job to do the D/C orders and paperwork.

In a grander sense my job is to keep things running smoothly on the floor and take care of the patient with the input of the surgeon as needed. The surgeons job is to understand my capabilities, oversee the care of the patient, be available for questions and of course do some surgery.

David Carpenter, PA-C

 

[prairiedog]

Independent decisions? Without physician supervision and approval? If you think PAs and NPs do not follow orders from physicians, you're being delusional.

Really, not even Tarus would say that, although probably agrees with you. What about the ED PA in a rural ED, has no supervision, needs no approval, what are they to do?

 

[foreverLaur]

Really, not even Tarus would say that, although probably agrees with you. What about the ED PA in a rural ED, has no supervision, needs no approval, what are they to do?

Clearly sit there confused and letting patients die.

 

[bradt9881]

Independent decisions? Without physician supervision and approval? If you think PAs and NPs do not follow orders from physicians, you're being delusional.

I follow orders. I also am not required by my SP to get approval for every dose change, lab test ordered, or referral.

 

[deleted6669]

Independent decisions? Without physician supervision and approval? If you think PAs and NPs do not follow orders from physicians, you're being delusional.

depends on the setting...for example I run a small dept without a physician on site.
they review my records after the fact but have no input into individual decisions I make about pts. I do not call them at 2 am to ask if I should admit or send home a pt, etc
I do not ask them about drug a vs drug b. I do not follow a protocol. I use my medical judgement as I have been trained to do. I run codes, intubate, cardiovert, stabilize and transfer trauma, etc.
this is not that uncommon. many small rural depts have distant physician backup available and all care review is done after the fact. in 8 years at my current job I have never called a physician to have them come eval a pt in the dept.
I transfer pts to a higher level of care all the time for diagnostic studies or consults not available at my facility but the decision to transfer or not is mine alone.

 

[Dimoak]

The point was that nurses work under physicians while PAs and NPs work with physicians. PAs and NPs have the right to make diagnostic decisions, order tests, write prescriptions, etc. PAs even have independent practice right (essentially) in some states.... they can run their own practice (basically).

Yes, but depending on the state, the diagnostics and treatments an NP or PA can perform can vary considerably. Certainly PAs and NPs have a right to make diagnostic decisions, order tests, and some in cases, write prescriptions; that's how FasTracks are generally run, and I have no problem with that (in fact as I mentioned earlier in this thread, I think it's a good idea because it lightens the load on EPs to work on the more complex cases). NPs and PAs are generally capable clinicians for a wide variety of cases. But the point is, directly or not, their actions are still supervised (whether by an inhouse physician or not), and their treatments for non straightforward cases as well as uncommon dispositions are still approved by physicians.

What about the ED PA in a rural ED, has no supervision, needs no approval, what are they to do?

Supervision doesn't necessarily imply a physician physically present at all times. Even the deep rural hospital EDs that have certain hours without physician coverage are still required to contract a physician group, which may actually be providing "supervision" for 5 different rural EDs in a 150 mile radius, and during such non-coverage times, the NPs and PAs running trauma are highly experienced and have specialized in-depth training for emergent procedures such as needle decompressions, etc. Even then, such EDs are required to have physicians contracted to be oncall when one isn't available in house. Certainly, if a PA or NP is faced with a life or death situation where they must act immediately, I certainly agree they should, but again these actions are not completely independent, as they are still legally doing so with the approval of whatever physicians are providing coverage for that facility, and those physicians are still at least partly responsible legally for the outcome.

I follow orders. I also am not required by my SP to get approval for every dose change, lab test ordered, or referral.

Yes, my point was that NPs and PAs are still midlevels and do follow orders from physicians. This is by no means insulting, degrading, or questioning their competence as clinicians; it is just part of their role in the healthcare team. Yes, PAs and NPs make their own medical decisions, but they are not entirely "independent" because they are still subject to approval by SPs, even if their approval is implied, and often does not need to be sought before performing each task. Generally, if an NP or PA feels a CXR or WBC is in order, they order it and 9999/10000 times the SP won't even be bothered about it. But if the PA or NP feel the patient needs an emergent ventriculostomy or to have their chest cracked, and the SP is available in house, most of the time they'll probably want to have a look, even if the PA or NP's call is completely accurate.

depends on the setting...for example I run a small dept without a physician on site.
they review my records after the fact but have no input into individual decisions I make about pts. I do not call them at 2 am to ask if I should admit or send home a pt, etc
I do not ask them about drug a vs drug b. I do not follow a protocol. I use my medical judgement as I have been trained to do. I run codes, intubate, cardiovert, stabilize and transfer trauma, etc.
this is not that uncommon. many small rural depts have distant physician backup available and all care review is done after the fact. in 8 years at my current job I have never called a physician to have them come eval a pt in the dept.
I transfer pts to a higher level of care all the time for diagnostic studies or consults not available at my facility but the decision to transfer or not is mine alone.

In my response, I was addressing a statement that "NPs and PAs do not follow orders from physicians, and make life or death decisions independently". As I mentioned earlier, I am a proponent of NPs and PAs running FasTrack, as this system has been successfully implemented in a myriad of EDs. My issue in particular with the usage of "independence" was that decisions made my NPs and PAs are still subject to approval, review, and revision by physicians, regardless of whether the aforementioned are valid. I am aware that it is not uncommon for NPs and PAs to completely dispo a pt and get a treatment going, but by law, these actions are still performed with the abject consent of a supervisory physician, implied or otherwise.

 

[foreverLaur]

some in cases, write prescriptions

I'm pretty sure that in most states PAs can prescribe Schedule II-V or III-V. Don't they also have DEA #s? I would go under the assumption that PAs and NPs write prescriptions fairly often... not just in some cases.

Heck my sister has gone to her dermatologist quite a few times. The doctor kept diagnosing her with rosacea (she has a thing with that... tried to diagnose with me with it as well despite meeting none of the criteria and then tries to get you to buy expensive products from her spa). My sister finally saw the PA who wrote my sister several prescriptons (without the authoriting of her SP) and solved all my sister's acne problems. She said she writes lots of scripts daily. A lot of PAs I have talked to write quite a few scripts daily. Not just "in some cases"

 

[meister]

Both PAs and NPs have DEA numbers, and both can prescribe medications in every state. There is much variance in the latitude they are given, but in many states they are allowed to do whatever CIII-CV and CII with some restrictions.

 

[Dimoak]

I'm pretty sure that in most states PAs can prescribe Schedule II-V or III-V. Don't they also have DEA #s? I would go under the assumption that PAs and NPs write prescriptions fairly often... not just in some cases.

Please reread my previous post. I wrote "some in cases, write prescriptions", which meant that in certain cases where the diagnosis and treatment calls for it, some PAs will write their own prescriptions. I'm sorry if I didn't write that clearly enough for you.

The physician assistant is a representative of the physician, treating the patient in the style and manner developed and directed by the supervising physician.

# Health care services delivered by physicians and Physician Assistants must be within the scope of each practitioners authorized practice as defined by state law.
# The physician is ultimately responsible for coordinating and managing the care of patients and, with the appropriate input of the Physician Assistant, ensuring the quality of health care provided to patients.
# The physician is responsible for the supervision of the Physician Assistant in all settings.
# The role of the Physician Assistant(s) in the delivery of care should be defined through mutually agreed upon guidelines that are developed by the physician and the Physician Assistant and based on the physician's delegatory style.
# The physician must be available for consultation with the Physician Assistant at all times either in person or through telecommunication systems or other means.
# The extent of the involvement by the Physician Assistant in the assessment and implementation of treatment will depend on the complexity and acuity of the patient's condition and the training and experience and preparation of the Physician Assistant as adjudged by the physician.
# Patients should be made clearly aware at all times whether they are being cared for by a physician or a Physician Assistant.
# The physician and Physician Assistant together should review all delegated patient services on a regular basis, as well as the mutually agreed upon guidelines for practice.
# The physician is responsible for clarifying and familiarizing the Physician Assistant with his supervising methods and style of delegating patient care.

Yes I recognize a lot has changed in the last 13 years since these guidelines were established, but these are how the current guidelines stand, and how PA practice is understood legally. I'm not sure what the guidelines are for NP, but I would imagine they are quite similar.

 

[lapelirroja]

Um, I don't think you know what a PA or NP is. They don't follow orders from physicians, nurses do. PAs and NPs DO make medical decisions, even life or death ones!

Please read about the professions and their training before you comment on midlevel clinicians...it's really quite offensive!

Yeah, so, the word INDEPENDENT is nowhere in my response, so I have no idea what the hell you guys are going back and forth about or why it is attributed to my statement. The whole point of my post is that PAs and NPs see patients and make decisions about treatment. They consult when they need to. They're not shadowing the MD/DO around the hospital, handing out pills and fluffing pillows.

 

[Dimoak]

Yeah, so, the word INDEPENDENT is nowhere in my response, so I have no idea what the hell you guys are going back and forth about or why it is attributed to my statement.

I was just trying to point out that the decisions made by NPs and PAs are not completely independent of physician supervision. The reason I was addressing your post in my statement was because of the "don't take orders from physicians" bit.

The whole point of my post is that PAs and NPs see patients and make decisions about treatment. They consult when they need to. They're not shadowing the MD/DO around the hospital, handing out pills and fluffing pillows.

I think that is an accurate statement.

 

[NPdoc2be]

The goal of the DNP is not to crank out health care providers EQUAL to medically trained physicians in practicing medicine but better trained Nurses to practice the art and science of nursing. Supposedly, the MSN training is already packed with more than most other MS prepared health related disciplines require and so the nursing establishment decided that it is only fair and sensible to add to bring it up to the standard of a doctorate as it would make no sense to subtract to make it more commensurate with other masters level programs.

Does the DNP indeed do this? I'm not totally sure to be honest and this is why I've been hesitant about pursuing it. Yet, I support the idea behind it. Assuming it does, just for the sake of the argument, would MD's and DO's still feel threatened? I'm sure. Should they? Perhaps a little--but only because society needs CLEARER delineations between what is the practice of medicine and what is the practice of nursing. DNP's should and could never supplant MD's or DO's. Medicine is medicine and nursing is nursing. But MD's and DO's do not need to resist the existence of DNP's. Sure, fight against what you perceive as territory stealing but at least acknowledge the right for an independent discipline to have an independent terminal degree without mischaracterizing it as some version of yours.

So if our fight is over these delineations with the primary motivation being public safety and then only secondarily professional territory, then fine! Let's duke it out. But if it's over cultural entitlements like the use of the title "Dr.," who gets to bill 3rd party payors, or who has access to the best hospital lounges then give me a break!

 

[237696]

The goal of the DNP is not to crank out health care providers EQUAL to medically trained physicians in practicing medicine but better trained Nurses to practice the art and science of nursing

Sorry, but these are the words of Dr. Mary Mundinger, the pioneer of the DNP degree and dean of Columbia's nursing school, and I think she very clearly states her intention that DNP nurses are not just equal to physicians in medical knowledge, but are superior and peerless in their delivery of medical care.

"DNPs are the ideal candidates to fill the primary-care void and deliver a new, more comprehensive brand of care that starts with but goes well beyond conventional medical practice. In addition to expert diagnosis and treatment, DNP training places an emphasis on preventive care, risk reduction and promoting good health practices. These clinicians are peerless prevention specialists and coordinators of complex care. In other words, as a patient, you get the medical knowledge of a physician, with the added skills of a nursing professional."

I have bolded the part that I think most physicians and medical students would most take exception with. I am also pretty sure that most primary care physicians would take exception to being labeled inferior coordinators of complex care.

 

[Taurus]

NP's must think that physicians are stupid. Look, we know when somebody is speaking from both sides of their mouth. No physicians believe NP's when they say that they just want to help. Here's their latest efforts in Texas.

In 2001, physicians and APNs agreed to a moratorium on scope of practice battles lasting three legislative sessions. That moratorium has now expired and on Monday, Feb. 9, CNAP stormed the Capitol with more than 400 APNs armed with reams of propaganda purporting the superiority of nurse practitioners in providing the coordinated care, patient education and proper follow-up for the management of chronic diseases. “Research supports NPs out-perform physicians in these areas,” claims one of the CNAP handouts.

Two bills filed this session would give broad prescriptive authority to APNs, virtually stripping all physician supervision of APNs from state law.​

Actions speak louder than words, my dear.