FP Journal Editor in chief wants to fully embrace NPs

[Denatured]

Read the source here

Jeff Susman, MD
Editor-in-Chief
[email protected]

It is time—time to abandon our damagingly divisive, politically Pyrrhic, and ultimately unsustainable struggle with advanced practice nurses (APNs). I urge my fellow family physicians to accept—actually, to embrace—a full partnership with APNs.

Why do I call for such a fundamental change in policy? First, because it’s the reality.

In 16 states, nurse practitioners already practice independently. And in many more states, there is a clear indication that both the public and politicians favor further erosion of barriers to independent nursing practice. Indeed, such independence is outlined in “The Future of Nursing: Leading Change, Advancing Health,” published by the Institute of Medicine (IOM) in October 2010. Among the IOM’s conclusions:

-Nurses should practice to the full extent of their education and training.
-Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
-Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.

Second, I believe our arguments against such a shift in policy don’t hold up. Despite the endless arguments about outcomes, training, and patient preferences, I honestly believe that most nursing professionals—just like most physicians—practice within the bounds of their experience and training.

Indeed, the arguments family physicians make against APNs sound suspiciously like specialists’ arguments against us. (Surely, the gastroenterologists assert, their greater experience and expertise should favor colonoscopy privileges only for physicians within their specialty, not for lowly primary care practitioners.) Rather than repeating the cycle of oppression that we in family medicine battle as the oppressed, let’s celebrate differences in practice, explore opportunities for collaboration, and develop diverse models of care.

Third, I call for a fundamental shift in policy because I fear that, from a political perspective, we have much to lose by continuing to do battle on this front. Fighting fractures our support and reduces our effectiveness with our legislative, business, and consumer advocates.

Finally, I’m convinced that joining forces with APNs to develop innovative models of team care will lead to the best health outcomes. In a world of accountable health care organizations, health innovation zones, and medical “neighborhoods,” we gain far more from collaboration than from competition.

As we ring in the new year, let’s stop clinging to the past—and redirect our energies toward envisionin g the future of health care.
The Journal Of Family Practice ©2010 Quadrant HealthCom Inc.

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[Socrates25]

Read the source here

Jeff Susman, MD
Editor-in-Chief
[email protected]

It is time—time to abandon our damagingly divisive, politically Pyrrhic, and ultimately unsustainable struggle with advanced practice nurses (APNs). I urge my fellow family physicians to accept—actually, to embrace—a full partnership with APNs.

Why do I call for such a fundamental change in policy? First, because it’s the reality.

In 16 states, nurse practitioners already practice independently. And in many more states, there is a clear indication that both the public and politicians favor further erosion of barriers to independent nursing practice. Indeed, such independence is outlined in “The Future of Nursing: Leading Change, Advancing Health,” published by the Institute of Medicine (IOM) in October 2010. Among the IOM’s conclusions:

-Nurses should practice to the full extent of their education and training.
-Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
-Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.

Second, I believe our arguments against such a shift in policy don’t hold up. Despite the endless arguments about outcomes, training, and patient preferences, I honestly believe that most nursing professionals—just like most physicians—practice within the bounds of their experience and training.

Indeed, the arguments family physicians make against APNs sound suspiciously like specialists’ arguments against us. (Surely, the gastroenterologists assert, their greater experience and expertise should favor colonoscopy privileges only for physicians within their specialty, not for lowly primary care practitioners.) Rather than repeating the cycle of oppression that we in family medicine battle as the oppressed, let’s celebrate differences in practice, explore opportunities for collaboration, and develop diverse models of care.

Third, I call for a fundamental shift in policy because I fear that, from a political perspective, we have much to lose by continuing to do battle on this front. Fighting fractures our support and reduces our effectiveness with our legislative, business, and consumer advocates.

Finally, I’m convinced that joining forces with APNs to develop innovative models of team care will lead to the best health outcomes. In a world of accountable health care organizations, health innovation zones, and medical “neighborhoods,” we gain far more from collaboration than from competition.

As we ring in the new year, let’s stop clinging to the past—and redirect our energies toward envisionin g the future of health care.
The Journal Of Family Practice ©2010 Quadrant HealthCom Inc.

As his first show of sincerity to these beliefs, and to fully integrate nurses as "full partners" with MDs, I expect him to step down from his clinical position IMMEDIATELY and appoint a nurse practitioner to replace him. Its entirely irresponsible to pay Dr Susman 150k a year for a job that an NP can do for 50% of that cost. Its the moral/ethical thing to do because the dollars saved can be used to provide more care for more people. What say you, Dr Susman? I expect your immediate resignation.

 

[deleted87716]

Its entirely irresponsible to pay Dr Susman 150k a year for a job that an NP can do for 50% of that cost.

I know you're being sarcastic, but it's worth pointing out that despite the oft-repeated belief that NPs are "cheaper" than physicians, there is actually no evidence whatsoever that this is the case, particulary since they're asking for payment parity.

 

[prairiedog]

I know you're being sarcastic, but it's worth pointing out that despite the oft-repeated belief that midlevels are "cheaper" than physicians, there is actually no evidence whatsoever that this is the case, particulary since they're asking for payment parity.

Is there any evidence to suggest PA/NP are more expensive?

 

[deleted87716]

Is there any evidence to suggest PA/NP are more expensive?

Yes.

http://www.acponline.org/clinical_information/journals_publications/ecp/novdec99/hemani.htm

 

[prairiedog]

Yes.

http://www.acponline.org/clinical_information/journals_publications/ecp/novdec99/hemani.htm

There must be a more recent study with more significance? If is this is all, one cannot conclude anything.

 

[PharmBound2011]

Is there any evidence to suggest PA/NP are more expensive?

Yes.

http://www.acponline.org/clinical_information/journals_publications/ecp/novdec99/hemani.htm

The study pertains only to NPs, not PAs.

 

[deleted87716]

The study pertains only to NPs, not PAs.

We weren't talking about PAs.

I've changed the word "midlevel" to "NP" in my earlier post, just to avoid any further confusion.

 

[deleted87716]

There must be a more recent study with more significance? If is this is all, one cannot conclude anything.

Dunno. Why don't you do a literature search and report back?

 

[Dwindlin]

Dunno. Why don't you do a literature search and report back?

Spoken like a true attending.

 

[deleted87716]

spoken like a true attending.

 

[Taurus]

Here's a better article about what can happen to your child if you take them to an NP. I look forward to reading more stories like these in the coming years and watching the rates of lawsuits and malpractice premiums rise. Of course, I will do my best to make it happen in reality. Taurus, closing one useless NP clinic down at a time.

Louisiana's limit on medical malpractice awards is unconstitutional, a state appeals court ruled.
Joe and Helena Oliver sought relief from the Louisiana Medical Malpractice Act, which shrank the damage award they received from $6.2 million to $500,000. The Olivers' daughter, Taylor, developed severe injuries after she was treated by a nurse who was practicing with only a high school degree.
Susan Duhon, a registered nurse practitioner and sole owner of the Magnolia Clinic, treated Taylor for vomiting, nausea and diarrhea.
Taylor visited the clinic 32 times in the first year of her life, and Duhon prescribed more than 30 medications to her. Duhon had a statutory duty to consult a physician, but Taylor never saw a doctor during any of her visits.
When Taylor was 14 months old, another hospital diagnosed her with neuroblastoma, a childhood cancer. One of the signs is severe bruising around the eyes, which Taylor had presented with at the Magnolia Clinic when she was 6 months old.
If neuroblastoma is diagnosed within the first year of life, the child has a 90 percent chance of an event-free recovery. Because of the delayed diagnosis, the quality of Taylor's life has been severely diminished.
Though Taylor survived the cancer, the tumor caused her head to become misshapen. Her eyes are abnormally large, and she is legally blind.
"Currently, to qualify as a nurse practitioner, a nurse is required to obtain a baccalaureate of science and a masters of science in nursing," the ruling states. "Although Ms. Duhon did not obtain any degree in nursing from an institution of higher learning, she was allowed to escape the more rigorous requirements enacted by statute with only a high school degree, under the 'grandfathered' exception."
The Olivers won their medical malpractice lawsuit, but their $6.2 million award shrank to less than one-twelfth of its original size under the state law.
The trial court ruled in the clinic's favor, but the Lake Charles-based appeals court agreed with the Olivers that the cap on malpractice damages is unconstitutional.
"The state offered no evidence in this case...to refute the fact that the cap discriminates against Taylor and her parents by limiting their general damage recovery to a single $500,000 payment, while allowing other less severely injured victims to fully recover their general damage awards," Judge Sylvia Cooks wrote in the court's lead opinion.
Two other judges on the court wrote concurring opinions, and Judge Shannon Gremillion dissented.​

 

[Denatured]

I'm not a fan of NP education, but that article is a poor representation of todays NP graduate. She never even attended nursing school. She must have gotten that degree 40 years ago.

 

[core0]

I'm not a fan of NP education, but that article is a poor representation of todays NP graduate. She never even attended nursing school. She must have gotten that degree 40 years ago.

If she is an NP she has a nursing degree. There are still a lot of diploma RNs out there. For that matter there are still a few certificate/diploma nursing programs out there. The original NP program was a 9 month certificate program. Hence the "only had a high school degree".

 

[Denatured]

If she is an NP she has a nursing degree. There are still a lot of diploma RNs out there. For that matter there are still a few certificate/diploma nursing programs out there. The original NP program was a 9 month certificate program. Hence the "only had a high school degree".

Didn't say she didn't have a degree. As a matter of fact my last line says "gotten that degree." I probably should have clarified that by "nursing school" I mean she never went to college. Hardly representative of a NP grad today is all I'm saying.

Also don't forget there is a study showing the longer a MD is in practice the worse outcomes they have.
http://www.medscape.com/viewarticle/499664

 

[Taurus]

I interact with NP's on daily basis so I have a pretty good perspective. It is truly scary how clueless many of them are. The other day, I had an NP come into the reading room to review the report. Her understanding of medicine was so basic that I felt I was talking to a kid. It was kinda cute if your life didn't depend on her skills.

Believe it or not, I am the biggest supporter of NP independence on SDN. If I had my way, I would kick every NP out of every practice and hospital in this country and force them to be independent. I'm confident that there are enough barely competent and marginal NP's out there that there will be an epidemic of similar lawsuits which will feed on itself and drive up insurance rates and salivating lawyers. This a $6.2 million verdict. She and her little clinic can't survive that. You don't need many lawsuits and similar verdicts to catch the attention of politicians, the public, media, lawyers, and insurance execs.

As I've said countless times before, the solution to the NP problem isn't through fighting legislation. That's throwing good money down the toilet. No. The solution is through the insurance marketplace and the lawyers. My wish is to see it so risky and expensive for NP's to go independent that only the best or the foolhardy would dare try.

This is why I don't support tort reform. My enemy's enemy is my friend as the saying goes. As long as most politicians are lawyers, I don't see tort reform happening anytime soon.

 

[Denatured]

I have to agree with the article that NP independence is happening and there isn't much that can stop it. Wouldn't a better strategy be to help guide NP education so that it is better and more rigorous? Wouldn't that be more productive and more beneficial to patients, especially in areas where NP independence is already a reality? Why isn't it an option to help them improve to a level we can all be satisfied with?

I know Taurus and Socrates and many other are against them no matter what, but is there anyone who would support assisting nursing in improving NP education? Blue dog? Emed? Futuredoc? bradT? Makati? Primadonna? Others? Many of you seem like reasonable people. Would you support NPs increasing admission requirements, clinical hours, didatics, implementation of residencies? Would you support NPs with a condition that improvements made, and help assisting in these improvements?

Maybe I'm just being naive, but I would think at this point it would best serve patients if we worked together to increase the knowledge and education of others.

 

[drift]

I have to agree with the article that NP independence is happening and there isn't much that can stop it. Wouldn't a better strategy be to help guide NP education so that it is better and more rigorous? Wouldn't that be more productive and more beneficial to patients, especially in areas where NP independence is already a reality? Why isn't it an option to help them improve to a level we can all be satisfied with?

I know Taurus and Socrates and many other are against them no matter what, but is there anyone who would support assisting nursing in improving NP education? Blue dog? Emed? Futuredoc? bradT? Makati? Primadonna? Others? Many of you seem like reasonable people. Would you support NPs increasing admission requirements, clinical hours, didatics, implementation of residencies? Would you support NPs with a condition that improvements made, and help assisting in these improvements?

Maybe I'm just being naive, but I would think at this point it would best serve patients if we worked together to increase the knowledge and education of others.

There already is a way for NPs to increase their didactic/clinical skills to safely practice independently to better serve our patients needs...


...in the 70's we called it med school; not sure what the kids call it these days. Seriously though, it is impossible to advance the practice of nursing to any degree to claim that it is enough to now safely practice medicine. They are wholly different approaches.

 

[fab4fan]

There already is a way for NPs to increase their didactic/clinical skills to safely practice independently to better serve our patients needs...


...in the 70's we called it med school; not sure what the kids call it these days. Seriously though, it is impossible to advance the practice of nursing to any degree to claim that it is enough to now safely practice medicine. They are wholly different approaches.

Why can't people just go to doctors anymore? I'm not saying this to be cute, I really mean it.

 

[Denatured]

There already is a way for NPs to increase their didactic/clinical skills to safely practice independently to better serve our patients needs...


...in the 70's we called it med school; not sure what the kids call it these days. Seriously though, it is impossible to advance the practice of nursing to any degree to claim that it is enough to now safely practice medicine. They are wholly different approaches.

This is part of what I am talking about. I can agree with that statement that medical school is already in place, but the NP independence cat has already come out of the bag. It's going to be almost impossible to eradicate. So instead of fighting the losing battle of "you should stop doing what your doing," wouldnt a more prudent answer be "you should really do this as well. Here's how we do it. Compensate us and you can utilize these resources that we have." sometimes you just have to play the cards you are dealt

I have no stake in this as I am not an NP. Just trying to think outside the box and create some discussion that isn't about how snooty some PAs are.

 

[Boatswain2PA]

wouldnt a more prudent answer be "you should really do this as well"....I have no stake in this as I am not an NP.

I agree with you, but, as I'm sure you know, the problem is the entities who set the standards for nursing have no incentive to improve the educational/clinical standards (beyond the financial incentive of pursuing the doctorate). The nursing boards simply keep increasing the definition of "scope of nursing" at will. They won't stop doing this until they hit a wall. It is my hope that the AMA, and state medical associations, start building that wall.

Also, I disagree with your statement that you have no stake in this. I think we all have a stake in this.

 

[Makati2008]

I have to agree with the article that NP independence is happening and there isn't much that can stop it. Wouldn't a better strategy be to help guide NP education so that it is better and more rigorous? Wouldn't that be more productive and more beneficial to patients, especially in areas where NP independence is already a reality? Why isn't it an option to help them improve to a level we can all be satisfied with?

I know Taurus and Socrates and many other are against them no matter what, but is there anyone who would support assisting nursing in improving NP education? Blue dog? Emed? Futuredoc? bradT? Makati? Primadonna? Others? Many of you seem like reasonable people. Would you support NPs increasing admission requirements, clinical hours, didatics, implementation of residencies? Would you support NPs with a condition that improvements made, and help assisting in these improvements?

Maybe I'm just being naive, but I would think at this point it would best serve patients if we worked together to increase the knowledge and education of others.

Honestly I think that NP education should be modeled after the PA model and only given the PA degree. It gives them the ability to be placed under the BOM(instead of nursing) as well as gives them a more rigorous cirriculum. This would also help to improve in clinical safety and help squash this debate. Also it would allow the NP indepence to fizzle out indirectly as well. I am wondering how that works for the program that gives the dual PA/NP degree to RN's(UC Davis maybe?) are they under the BOM, BON, or both?

 

[deleted87716]

I have to agree with the article that NP independence is happening and there isn't much that can stop it. Wouldn't a better strategy be to help guide NP education so that it is better and more rigorous?

Nursing education isn't my job.

Besides, they haven't asked for our help. They don't think they need it.

However, I am in favor of independent NPs being regulated by the BOM, or jointly by the BON and BOM (as is already the case in some states, including mine). Most nursing boards have no experience regulating independent practitioners.

 

[Denatured]

Honestly I think that NP education should be modeled after the PA model and only given the PA degree. It gives them the ability to be placed under the BOM(instead of nursing) as well as gives them a more rigorous cirriculum. This would also help to improve in clinical safety and help squash this debate. Also it would allow the NP indepence to fizzle out indirectly as well. I am wondering how that works for the program that gives the dual PA/NP degree to RN's(UC Davis maybe?) are they under the BOM, BON, or both?

Depends on which license they are practicing under. I think you have to be hired as one or the other.

And I agree, blue dog, that nursing is a stubborn beast, but I'm just speaking in hypotheticals. This is getting off topic with BON/BOM, etc.


Would you support NPs in increasing their education? Yes or no. If yes, how would you propose to help? If no, why wouldn't you help?

 

[deleted87716]

Would you support NPs in increasing their education?

Why? Hasn't their nursing education prepared them adequately for the job they're trying to do?

They're either up to the task, or they aren't.

 

[Taurus]

This is part of what I am talking about. I can agree with that statement that medical school is already in place, but the NP independence cat has already come out of the bag. It's going to be almost impossible to eradicate.

It's not about eradication. It's about containment and clearly defining the boundaries.

Let me elaborate. Physicians have a license to practice medicine and surgery. Over time, because of licensing and credentialing, physicians are forced by hospitals and insurance companies to practice in only areas where they have demonstrated competence. For example, you won't see a internist doing an appendectomy anywhere in this country. How did this happen? Because of the lawsuits against physicians and hospitals. I want to see something similar happen to NP's and CRNA's. Just because the states loosen their laws, only a naive nurse would think that they suddenly can do everything that a physician can do forever. No. As similar cases of negligence work their way through the courts, hospitals and insurance companies will begin to limit the scope of NP's and CRNA's. Only the smartest, best trained, and most knowledgeable NP or CRNA will have a scope anywhere close to a physician in the future. It will basically be a return to where we are today.

So, let the DNP who got her degree online and only 700 hours of clinical training at the local botox clinic open her own little practice. Give her all the same privileges at the hospital. Then, step back and watch it blow up in the DNP's faces.

This is why it is so critical that physicians stay as far away from these NP's as possible. You don't want to stand anywhere near them when the **** hits the fan because they will try to hide behind you and your license.

 

[Paseo Del Norte]

Nursing education isn't my job.

Besides, they haven't asked for our help. They don't think they need it.

However, I am in favor of independent NPs being regulated by the BOM, or jointly by the BON and BOM (as is already the case in some states, including mine). Most nursing boards have no experience regulating independent practitioners.

Physicians should have a hand in nursing education. Most every other allied health programme (Respiratory therapy, paramedic and so on) has a physician medical director, the same should be true of every nursing school in the United states.

I disagree with having the term independent anywhere in the NP scope of practice. Assuming, that a "good" NP programme can be created with a solid foundation in the sciences that basically mirrors a PA like curriculum, the absolute most I would ever agree on would be regulation by a BOM and a requirement for physician collaboration.

Why? Hasn't their nursing education prepared them adequately for the job they're trying to do?

They're either up to the task, or they aren't.

We both know and I think agree on what the answer to this question is.

It's not about eradication. It's about containment and clearly defining the boundaries.

Let me elaborate. Physicians have a license to practice medicine and surgery. Over time, because of licensing and credentialing, physicians are forced by hospitals and insurance companies to practice in only areas where they have demonstrated competence. For example, you won't see a internist doing an appendectomy anywhere in this country. How did this happen? Because of the lawsuits against physicians and hospitals. I want to see something similar happen to NP's and CRNA's. Just because the states loosen their laws, only a naive nurse would think that they suddenly can do everything that a physician can do forever. No. As similar cases of negligence work their way through the courts, hospitals and insurance companies will begin to limit the scope of NP's and CRNA's. Only the smartest, best trained, and most knowledgeable NP or CRNA will have a scope anywhere close to a physician in the future. It will basically be a return to where we are today.

So, let the DNP who got her degree online and only 700 hours of clinical training at the local botox clinic open her own little practice. Give her all the same privileges at the hospital. Then, step back and watch it blow up in the DNP's faces.

This is why it is so critical that physicians stay as far away from these NP's as possible. You don't want to stand anywhere near them when the **** hits the fan because they will try to hide behind you and your license.

I absolutely disagree. The nurse in me could not stand idly by and watch patients being placed at risk in the hopes that the fallout would "contain" this issue. Is it not our job and perhaps duty to protect patients?

 

[deleted87716]

The nurse in me could not stand idly by and watch patients being placed at risk in the hopes that the fallout would "contain" this issue. Is it not our job and perhaps duty to protect patients?

Precisely.

 

[deleted6669]

is there anyone who would support assisting nursing in improving NP education? Blue dog? Emed? Futuredoc? bradT? Makati? Primadonna? Others? Many of you seem like reasonable people. Would you support NPs increasing admission requirements, clinical hours, didatics, implementation of residencies? Would you support NPs with a condition that improvements made, and help assisting in these improvements?

YES. that would basically turn them into pa programs.(not trying to be mean, just realistic).currently a pa who gets a certificate or an a.s. gets more clinical exposure than a dnp by a factor of at least 2:1.

 

[deleted6669]

I am wondering how that works for the program that gives the dual PA/NP degree to RN's(UC Davis maybe?) are they under the BOM, BON, or both?

both- they take both tests and have both licenses. when they get a job as a pa they report to the bom. when they take a job as an np they report to the bon. there are folks who have taken the other program after finishing their primary one(np to pa or vis versa) and it works the same way. basically you work as a pa or an np but not both at the same time at the same place although you could work at 2 places and be an np at one and a pa at the other.

 

[Denatured]

YES. that would basically turn them into pa programs.(not trying to be mean, just realistic).currently a pa who gets a certificate or an a.s. gets more clinical exposure than a dnp by a factor of at least 2:1.

At least one person can work past the bias against NPs. Thanks emed.

So how would you feel if PA residencies were opened up to NPs? If not offered outright, perhaps it could be offered on the condition that the NP take gross anatomy and a medical physiology course (to coincide with the already required pathophysiology course). They say in the IOM report they want residencies and since these are already in place it would make an easy transition.

Of course I don't expect anything to come of these discussions. Just ideas.

 

[deleted87716]

So how would you feel if PA residencies were opened up to NPs?

What would that accomplish? It wouldn't make them PAs.

 

[Denatured]

What would that accomplish? It wouldn't make them PAs.

It would provide them with an opportunity to advance their clinical knowledge. I'm not looking to make them PAs. You don't seem to get my point. If you just want to sit by and do nothing to advance other providers, or even discuss it, that is your prerogative.

 

[deleted87716]

It would provide them with an opportunity to advance their clinical knowledge.

They still wouldn't be qualified to practice independently.

 

[Denatured]

They still wouldn't be qualified to practice independently.

Not saying they would. Still not getting it.

 

[deleted87716]

Not saying they would. Still not getting it.

Enlighten me.

Why bother increasing someone's education if they just end up doing the same thing that they could've done otherwise?

That's the main issue people have with the DNP, after all.

The bar for independent practice has been set. Nothing short of medical school and residency will make an NP qualified to practice independently.

 

[Denatured]

Enlighten me..

Ive already tried. I assume you want to keep the status quo of you lobbying against them and losing. Not trying to be mean, that's just what's been happening or they wouldn't have independence in the first place.

Why bother increasing someone's education if they just end up doing the same thing that they could've done otherwise?.

So since they already have independent practice, we and they should just ignore the fact that the majority (NPs as well as others) think that they could use more education? Is that what you are saying?

That's the main issue people have with the DNP, after all.

The bar for independent practice has been set. Nothing short of medical school and residency will make an NP qualified to practice independently.

That doesn't change that they have independent practice in some states already. What we can change is their education.

 

[Taurus]

The nurse in me could not stand idly by and watch patients being placed at risk in the hopes that the fallout would "contain" this issue. Is it not our job and perhaps duty to protect patients?

How can I protect the patient being seen by an autonomous NP who doesn't know when to refer patient to a physician? That patient will only be seen by the NP until it's too late. Is it not the responsibility of the NP to know when they're above their heads? How many people would risk their health on NP's being wise enough to know when they don't know enough?

You and I both know the answers. Patients will get hurt -- many will die prematurely -- because of these marginally-trained NP's who don't feel that they need physician involvement. That's what they're taught in nursing school now. These cases will mushroom. Multi-million dollar lawsuits will be filed and won. It's inevitable. Physicians have decades of experience in this medicolegal environment and this model is what eventually happens. Hospitals are very risk-averse. As soon as one of their autonomous NP's screws up, there will be a lot of hand wringing and consternation. As with any bureaucratic institution, new restrictive policies created by committee based on degree, cert, etc. will get passed. In the future, the only place that NP's could practice independently will be if they open their own practices, which is not without its many pitfalls. The future won't look so different as today.

 

[deleted87716]

I assume you want to keep the status quo of you lobbying against them and losing.

We haven't lost, actually...not in my state.

 

[deleted6669]

So how would you feel if PA residencies were opened up to NPs? If not offered outright, perhaps it could be offered on the condition that the NP take gross anatomy and a medical physiology course (to coincide with the already required pathophysiology course). They say in the IOM report they want residencies and since these are already in place it would make an easy transition.
.

Some already accept pa or np like st lukes critical care/trauma in pennsylvania and at least one of the psych residencies takes both.
in general there are not currently enough spots for all the pa's who want to do one so that would be an issue.
ideally I think all midlevels should do a 1 yr residency in their specialty but that's just me. at some point I think it will happen.
the other issue is that what the np programs really need is more solid didactics and clinicals as part of their initial training, not a bandaid residency after they are already licensed.

 

[Denatured]

Some already accept pa or np like st lukes critical care/trauma in pennsylvania and at least one of the psych residencies takes both.
in general there are not currently enough spots for all the pa's who want to do one so that would be an issue.
ideally I think all midlevels should do a 1 yr residency in their specialty but that's just me. at some point I think it will happen.
the other issue is that what the np programs really need is more solid didactics and clinicals as part of their initial training, not a bandaid residency after they are already licensed.

True, there are a couple that take both, but I'm sure with can both agree that there is a tendency to take PAs, especially in the St. Lukes program. Not that I blame them for wanting PAs over NPs.

The spots are limited, but hopefully they will expand further in the future. It is cheap labor after all. I'm sure residency requirements at least for PAs will eventually come to pass.

Well of course they need better basic education and clinicals. Preaching to the choir. The trick is to how do we make them want to do these things. Leading the horse to water and making him drink is no simple chore, but maybe if you add a little sugar to it.

Another great idea would be to open more of the dual NP/PA programs. UC Davis is the only one left to my knowledge. Didn't they use to have one at Drexel, or maybe it was Medex...or maybe I'm confused because you went to one of those didn't you?

 

[deleted6669]

Another great idea would be to open more of the dual NP/PA programs. UC Davis is the only one left to my knowledge. Didn't they use to have one at Drexel, or maybe it was Medex...or maybe I'm confused because you went to one of those didn't you?

STANFORD used to have one. the problem with the dual programs is that as of 2015 they would all have to be doctorate(dnp) level and many folks( I'm talking pa applicants here) don't want to put in that kind of time and money and not end up a physician.
I teach both pa and np students in the er. the np's do 40 hrs over 2 weeks and the pa's do 250-300 hrs over 5-6 weeks. it would be hard to convince the np's to increase their clinicals to that extent.
( and yes, I went to drexel back when it was hahnemann)

 

[brisbane]

Anyone care to elaborate on why in God's name did the American Board of Physician Specialties appointMary O'Neill Mundinger to Board of Certification in Emergency Medicine? Of all people? Really? Genius.

http://www.benzinga.com/press-relea...on-in-emergency-medicine-bcem-appoints-public

 

[Hernandez]

anyone care to elaborate on why in god's name did the american board of physician specialties appointmary o'neill mundinger to board of certification in emergency medicine? Of all people? Really? Genius.

http://www.benzinga.com/press-relea...on-in-emergency-medicine-bcem-appoints-public

wtf?

 

[drift]

I fully embrace NPs...


...As long as embrace means giving hugs all day long.

 

[deleted6669]

Anyone care to elaborate on why in God's name did the American Board of Physician Specialties appointMary O'Neill Mundinger to Board of Certification in Emergency Medicine? Of all people? Really? Genius.

http://www.benzinga.com/press-relea...on-in-emergency-medicine-bcem-appoints-public

BCEM isn't recognized by the vast majority of physicians as a legitimate board certification. adding dnp's to the list of eligible folks who can become (NON) boarded in em by "an organization which credentials physicians" would go far towards advancing the dnp specialty cause. "complete this dnp "residency" and get the "same" specialty credential physicians get".
it's brilliant really. no one will fight it because no one considers it a real board but the public won't know the difference when they see:
DR. Jane Doe
Residency trained/Board certified, emergency medicine.
what it gets ABPS is another potential group of applicants(DNP's) paying big bucks for their "certification".

 

[oldiebutgoodie]

http://online.wsj.com/article/SB100...4.html?mod=googlenews_wsj#articleTabs=article

Interesting responses, pro and con, of nurse practitioners, from the Wall Street Journal.

Oldiebutgoodie (disclaimer: FOR MD supervision of NPs, AGAINST the DNP in its current form).

 

[Denatured]

http://online.wsj.com/article/SB100...4.html?mod=googlenews_wsj#articleTabs=article

Interesting responses, pro and con, of nurse practitioners, from the Wall Street Journal.

Oldiebutgoodie (disclaimer: FOR MD supervision of NPs, AGAINST the DNP in its current form).

NP says 3-5 years experience is needed before entering a 2 year program. Must be psychnp at it again with her delusions.

 

[Therapist4Chnge]

Physicians should have a hand in nursing education. Most every other allied health programme (Respiratory therapy, paramedic and so on) has a physician medical director, the same should be true of every nursing school in the United states.

That will never happen. "They won't understand nursing theory, so they cannot lead a program" would be the response of every nursing program. This obviously ignores that many/most heads of organizations are outsiders, since running an organization is about business.

 

[Paseo Del Norte]

That will never happen. "They won't understand nursing theory, so they cannot lead a program" would be the response of every nursing program. This obviously ignores that many/most heads of organizations are outsiders, since running an organization is about business.

That is a hollow argument IMHO and nursing reminds me of my days in the military. A perfect analogy comes to mind: I remember when a "new" and exciting modality was "discovered." I distinctly remember watching videos this new modality. The Rangers had apparently perfected a modality that was analogous to a saline lock. However, it was called the "Ranger saline lock."

The same analogy applies to nursing. Nursing does not do anything unique, we simply give a nursing twist to the names of various modalities. However, the modalities themselves remain the same. Once you make this leap of logic so to speak, understanding nursing theory is really quite easy.

For example; take a person with an "airway obstruction" to the rest of the world. In Nursonics, it is translated as "ineffective airway clearance." Understanding my profession is nothing more than translation. Heck, I would be more than happy to teach prospective physician medical directors the language. For a small fee of course...