IOM supports removing scope of practice restrictions from Nurses

[oldiebutgoodie]

So, do you guys speak up within your specialty organizations? The Mundinger groupies would have us believe that all of nursing is marching in lockstep to their drumbeat for increased scope. My experience, and I suspect yours, is different.

So, why is a vocal minority deciding the future of nursing?

For the same reason a vocal minority decides the future of medicine. (or doesn't decide). Does the AMA reflect your opinions? Why doesn't the AMA hire a decent PR firm so that the public doesn't think you guys are out on the golf course all the time?

In order to influence nursing policy, one would have to get a PhD in nursing, become a professor, do research, and make no money. Many of us need to work in order to make money, feed, clothe, and house ourselves.

But, no, I am not in favor of APN-MD equality. I respect the MD's education, and I sure wish the academics would shut their pie holes.

Oldiebut goodie

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[deleted87716]

In order to influence nursing policy, one would have to get a PhD in nursing, become a professor, do research, and make no money.

Bullsh-t.

"All that is necessary for evil to triumph is for good men to do nothing." - Edmund Burke

 

[fab4fan]

Bullsh-t.

"All that is necessary for evil to triumph is for good men to do nothing." - Edmund Burke

Well, I also put my money where my mouth is. I won't have my care given by a midlevel. When I need care, I make sure my provider is a physician. It's my right as a patient. The last time I was going to have elective surgery, I specifically requested an MDA. When I need to be seen for minor ailments, I see my physician, not the office PA.

 

[PSYCHNP]

I am getting tired of seeing PAs stating that they are better trained than NPs. First of all, NPs are advanced practice nurses. They must first become registered professional nurses with a minimun of one year of professional experience. Nursing shool is not a "walk in the park", neither is the nursing licensing exam. Many of these nurses prior to going on to NP schools have worked in ICUs, ERs, and other acute care departments. Even an experienced PA would need some form of training/preceptoring to work in an ICU in the role of an ICU RN.

In the case of a PA working in psychiatry: How many semesters of training do they have? If it is one semester that is far less than the six semesters the psychiatric nurse practitioner would have (covering group therapy, psychotherapy, and psychopharmacology). You see, nurse practitioners must get training and specialize in a given clinical area. That goes for CRNAs, Family, Psych, and Adult nurse practitioners. In the case of the PA where is the expertise? More could be less!!! Always remember ARNPs are advance practice nurses.

 

[Denatured]

I try being subtly witty, but apparently it is lost in print. I was being facetious.

Well, we must understand that nursing is much more fragmented than the groups that push for this craziness would have you believe. You have many nurses like my self who are essentially "blue collar" nurses with associate degrees that are basically only good at manual labour and menial nursing tasks. There exists a whole lot of pretentious attitude regarding the stratification of nurses based on a degree or lack there of when considering practical nurses. You do not often see people like my self at the front making and pushing policy. It is quite easy to write us off. Or simply look at my statements as the rambling of an associate degree nurse who has a hardon for nurses with more education.

In addition, many really do not care all that much. They are like me and simply want to work, make money and go home without all the other stuff. Nor do many feel any need to take time and energy out to fight against the status quo. Of course, I honestly have no idea how many nurses truly support this movement and how many oppose.

To answer the question, I am a member of only one nursing orgainasition, the ENA. The primary reason I signed up was to get a nice discount on the certified emergency nurse and certified flight registered nurse board examinations. Oh, and the ENA journals provide me with material to complete my weekly article review requirement in respiratory school. Rest assured, I have sent letters and have openly debated the issue with other nurses. I have also had blunt discussions with my respiratory classmates and instructors.

However, this is my honest opinion: Change will not come from nursing. No super secret nurse spy is going to topple the inertia of the current movement. This ninja, defeat from within stuff would not even pan out in Taurus' wettest dreams. (Sorry guy, I just had to say it, but hopefully you all get the point.) Physician groups need to mobilise, connect with the public, produce data, and ultimately push change through legislation.

Fab, you are pretty much correct, no super spy stuff for me...

 

[Denatured]

You are adding to the fodder. You argue on what you do not know.

I am getting tired of seeing PAs stating that they are better trained than NPs. First of all, NPs are advanced practice nurses. They must first become registered professional nurses with a minimun of one year of professional experience. Nursing shool is not a "walk in the park", neither is the nursing licensing exam. Many of these nurses prior to going on to NP schools have worked in ICUs, ERs, and other acute care departments. Even an experienced PA would need some form of training/preceptoring to work in an ICU in the role of an ICU RN.

In the case of a PA working in psychiatry: How many semesters of training do they have? If it is one semester that is far less than the six semesters the psychiatric nurse practitioner would have (covering group therapy, psychotherapy, and psychopharmacology). You see, nurse practitioners must get training and specialize in a given clinical area. That goes for CRNAs, Family, Psych, and Adult nurse practitioners. In the case of the PA where is the expertise? More could be less!!! Always remember ARNPs are advance practice nurses.

 

[Dwindlin]

I am getting tired of seeing PAs stating that they are better trained than NPs. First of all, NPs are advanced practice nurses. They must first become registered professional nurses with a minimun of one year of professional experience. Nursing shool is not a "walk in the park", neither is the nursing licensing exam. Many of these nurses prior to going on to NP schools have worked in ICUs, ERs, and other acute care departments. Even an experienced PA would need some form of training/preceptoring to work in an ICU in the role of an ICU RN.

In the case of a PA working in psychiatry: How many semesters of training do they have? If it is one semester that is far less than the six semesters the psychiatric nurse practitioner would have (covering group therapy, psychotherapy, and psychopharmacology). You see, nurse practitioners must get training and specialize in a given clinical area. That goes for CRNAs, Family, Psych, and Adult nurse practitioners. In the case of the PA where is the expertise? More could be less!!! Always remember ARNPs are advance practice nurses.

If you're referring to comments posted on this board then I am afraid you're ranting at the wrong people. PA's aren't saying they are better trained. Physicians are saying they are better trained. And frankly they are. Sorry.

 

[drift]

For the same reason that NPs shouldn't be given more autonomy. Both groups are already practicing "to the full extent of their education and training." Medical practice should be based on competency, not politics.

Lowering the bar for the independent practice of medicine would accomplish nothing (aside from endangering the public) without payment reform for primary care services. If primary care is unattractive to physicians, it will be equally unattractive to anyone else.

I am not a proponent for independent practice for any midlevels at all, they simply don't get the education necessary for them to function in such a role. Although, unlike what blue dog said, I don't believe both (PA & NP) are practicing to the "full extent of their license." While it may sometimes be easier to refer to them interchangeably since they infact midlevels, I don't agree that PAs should be lumped in with NPs. They aren't one and the same.

Since PAs are trained better then NPs (IMO), then i would make sense that PAs would be able to exercise more autonomy in practice then an NP (although STILL SUPERVISED). This is hardly the case. NPs are pushing for more independence, although in actuality any educated individual could clearly see that their current scope of practice needs to be considerably limited. There are equally as many NPs as PAs in America, I don't see why they are left out of the equation and the lesser trained group is out there pushing to become a doctor.

Independent practice won't solve any problems. NPs would still see the same amount of patients in a day than if they were dependent, they would just have no back-up when a patient they can't treat walks in through the door.

 

[PSYCHNP]

I think that if a nurse wants to be a physician he or she should go to medical school. Yet, I do believe that there is a role that advanced practice nurses could fill.

I believe that PAs and advanced practice nurses have a quite different educational path. There are several advanced practice nurse specialties. These include gerontology, adult acute care NP, pediatric acute care NP, midwifery, CRNA, neonatal NP, psychiatric mental health, family, and adult. The advanced practice nurse completes his or her program and sits a certification examination in that given area.

I have had colleages at my university who were serious about pediatrics, so they took the pediatric acute care track. It was six semesters in length and was not online. Would a PA have more training in pediatric acute care? Maybe not. I see medical professionals say they have more than one specialty ( i.e. endocrionolgy and family medicine). Often times they lack mastery in either field. As far as primary care is concerned I think the ANA is on the right track by making advanced practice nurses specialize. I think that it facilitates autonomy and not just being a physician extender (like a PA).

 

[drift]

I think that if a nurse wants to be a physician he or she should go to medical school. Yet, I do believe that there is a role that advanced practice nurses could fill.

I believe that PAs and advanced practice nurses have a quite different educational path. There are several advanced practice nurse specialties. These include gerontology, adult acute care NP, pediatric acute care NP, midwifery, CRNA, neonatal NP, psychiatric mental health, family, and adult. The advanced practice nurse completes his or her program and sits a certification examination in that given area.

I have had colleages at my university who were serious about pediatrics, so they took the pediatric acute care track. It was six semesters in length and was not online. Would a PA have more training in pediatric acute care? Maybe not. I see medical professionals say they have more than one specialty ( i.e. endocrionolgy and family medicine). Often times they lack mastery in either field. As far as primary care is concerned I think the ANA is on the right track by making advanced practice nurses specialize. I think that it facilitates autonomy and not just being a physician extender (like a PA).

a PA would have more training. A NP is TRAINED to be much more of a physician extender then any PA.

A Pediatric NP will get around 600 hours of pediatric medicine in their program.

A PA will get 600 in Family Care, 500 in internal medicine, 300 in pediatrics, 400 in surgery, 300 in ......blahblah



Medicine is not a narrow field. There is a reason a Psychiatrist goes to medical school. You need to learn about other fields of medicine to understand your own. You learn things in an internal medicine rotation that are useful in your pediatric rotation, which are useful in your psychiatry rotation.

PAs get the "specialized" knowledge that NPs get along with 1500 hours in other medical fields so they are better able to function in whatever specialty they do.

an NP is NOT specialized. An NP is trained narrowly.

Do you really believe a Pediatric NP doesnt "lack mastery" in her field?

The only person who I will believe has any kind of mastery in their field is a Physician with years of residency and fellowship training.

 

[PSYCHNP]

I am glad you noted yourself that the NP would have 600 hours of clinicals as opposed to 300 by the PA. What about the theory? The advanced practice nurse would learn topics related to the his or her specialty each semester.

What you are also leaving out is that the NPs have had professional experience working on the pediatric nursing unit as RNs. You might ask yourself what is so great about being an RN? I have yet to see a PA as the director/manager of an ICU, Emergency room, psychiatric unit, medical sugical unit, hospital or even nursing home. Yes, RNs historically have held these leadership positions and an RN with a MSN or DNP is prime for such a position. Nursing staff make up the bulk of a hospital's employees. With 2.9 million RNs in the U.S., not to mention CNAs, and LPNs and I don't see a PA suited for these leadership positions. Like I said, the PA seems to be a great physician extender.

 

[PSYCHNP]

As advanced practice nurses we are not looking to be brain surgeons. We want to be able to do what we do while you all do what you do.

 

[drift]

I am glad you noted yourself that the NP would have 600 hours of clinicals as opposed to 300 by the PA. What about the theory? The advanced practice nurse would learn topics related to the his or her specialty each semester.

What you are also leaving out is that the NPs have had professional experience working on the pediatric nursing unit as RNs. You might ask yourself what is so great about being an RN? I have yet to see a PA as the director/manager of an ICU, Emergency room, psychiatric unit, medical sugical unit, hospital or even nursing home. Yes, RNs historically have held these leadership positions and an RN with a MSN or DNP is prime for such a position. Nursing staff make up the bulk of a hospital's employees. With 2.9 million RNs in the U.S., not to mention CNAs, and LPNs and I don't see a PA suited for these leadership positions. Like I said, the PA seems to be a great physician extender.

PAs mean health care experience was 41 months last year. That's almost 4 years. But do we count that as training? No. Time spent in school is time you put towards the degree you are practicing with.

And PLEASE don't get my started on your didactic education. I'm sick of discussing DNP fluff classes to the point that I just give up and don't mention them. I think you get the point; if you don't, you will let me know.

Historically RNs have held such positions; it's because they have the leasure to do so. A PA would be more valuble to a practice/hospital doing patient care.

Which begs to ask the question, as a "Advanced Practice Nurse" do you seriously NOT consider yourself a Physician extender?

As advanced practice nurses we are not looking to be brain surgeons.

Ofcourse your not, funny you even mention it

 

[drift]

We want to be able to do what we do while you all do what you do.

No. You are trying to do exactly what we do.

 

[Denatured]

You've had one sip to many of the kool aid and the debate skills of a 3rd grader. Please stop before I join in with the others in making you look bad.

PAs are just as well trained as NPs. The real difference is more important based on individuals. Not all NPs have prior experience, Many PAs do. A PA is the Directors of Emergency Services at Johns Hopkins, so that bust the leadership thing you had going.

They are both equal with Some PAs being better than NPs and vice versa. Nurses just happen to be in a position to control their future. Leave it at that.

I am glad you noted yourself that the NP would have 600 hours of clinicals as opposed to 300 by the PA. What about the theory? The advanced practice nurse would learn topics related to the his or her specialty each semester.

What you are also leaving out is that the NPs have had professional experience working on the pediatric nursing unit as RNs. You might ask yourself what is so great about being an RN? I have yet to see a PA as the director/manager of an ICU, Emergency room, psychiatric unit, medical sugical unit, hospital or even nursing home. Yes, RNs historically have held these leadership positions and an RN with a MSN or DNP is prime for such a position. Nursing staff make up the bulk of a hospital's employees. With 2.9 million RNs in the U.S., not to mention CNAs, and LPNs and I don't see a PA suited for these leadership positions. Like I said, the PA seems to be a great physician extender.

 

[deleted6669]

on pa education:
I don't know of any pa programs with less than 2000 hrs of clinical training.
I don't know of any np programs with more than 1000(and most have 500-800).

my full time clinical yr(54 weeks ) was this:

trauma surgery 5 weeks( over 500 hrs)
inpt. internal med. 5 weeks
obgyn 5 weeks ( L+D, clinic, and o.r.)
inpt. psych 5 weeks (lockdown facility)
em 5 weeks
peds em 5 weeks (at well known children's hospital)
fp 12 weeks
em elective 12 weeks

an "emergency nurse practitioner" (there are 2 programs) gets 800 hrs of clinicals total. I had over 3000 hrs with most of it in em or trauma(27 weeks). I was also a 911 and critical care paramedic in several busy urban systems for years before pa school.
who is better prepared to practice em, the " em specialty np" or the "general pa"?
what about family medicine? I had more primary care rotations than a "specialty family np" who gets 500-800 hrs total compared to my 1500 hrs in primary care....who is the specialist now? and I know that if I took a primary care job I would still have a lot to learn because 1500 hrs is nothing compared to the 3 yrs of residency an fp doc does.

on "leadership":
I have worked as an associate chief of a community emergency dept before.
the current associate chief at my primary job now(different place than where I was assoc. chief) is a pa.
as mentioned above most pa's don't want to work in administration, it's not that they can't. I could only stand it for 2 years before I resigned the position. there are plenty of admin and lead pa positions out there, look in any pa magazine's job section in back; chief pa's, practice directors and coordinators, research positions, etc

I know some great np's as well as some terrible ones(ditto pa, md, rn, etc).
pa's get a great medical education but we are not docs. we recognize that to become docs we have to go back to med school. there is now a pathway for this to happen(open to pa's only) that takes 3 years at lake erie college of osteopathic medicine.
all pa's and np's should work in teams with physician oversight.
end of story.

 

[PSYCHNP]

Right, PAs don't have the time to be in administration, medical directors, or clinical educators while MDs and RNs do. Some of these positions pay quite well. Let's not be naive.

Anyhow, I just wanted to stand up for nurses in this debate. Studies show that both PAs and NPs can be effective healthcare providers.

 

[drift]

Right, PAs don't have the time to be in administration, medical directors, or clinical educators while MDs and RNs do. Some of these positions pay quite well. Let's not be naive.

In this thread itself, I just saw 3 examples of PAs in leadership roles. MDs don't have the time for it too several times. An RN in hospital administration generally only makes about 10-20% more money then if she was just a staff nurse.

Did you say an RN as a MEDICAL DIRECTOR?!

 

[deleted6669]

Did you say an RN as a MEDICAL DIRECTOR?!

not going to happen.
medical directors are always physicians.
adminisitrative director? sure.

 

[PSYCHNP]

Yes, I did say a nurse as a medical director. A psychiatric facility was looking for a psychiatric mental health nurse practitioner to fill the position. I guess it would be more cost effective for them.

 

[deleted6669]

Yes, I did say a nurse as a medical director. A psychiatric facility was looking for a psychiatric mental health nurse practitioner to fill the position. I guess it would be more cost effective for them.

wouldn't that be an "advanced nursing director"?
you know, because np's don't practice medicine they practice "advanced nursing".....
never been able to figure out why if I suture or a doc does it's "practicing medicine" but if an np does it's "practicing advanced nursing".....

 

[PSYCHNP]

Let's not get into exceptions rather than the norm. My point is that advanced practice nurses are prime for such leadership positions because the majority of a hospital's/healthcare facility's employees are generally nursing staff.

 

[PSYCHNP]

Good point. Anyhow, I guess in psych complex medical cases are generally referred out.

 

[Denatured]

Emed, your friend jmj (the pain specialist) posted a while back about how he thought PAs could become independent after a period of time, and I tend to agree with him. And while I don't think with their current educational model NPs should be independent out of the gate, I think NPs with time could as well. I'm a fan of Maine's model where you are independent after 2 years of full time practice in your specialty.

PsychNP, considering your glaring lack of research and astute observation on other topics in this thread, I have a hard time believing there is a Medical director position open for an NP. But I tell you what, you provide a link or other evidence and I will believe you.

 

[Denatured]

wouldn't that be an "advanced nursing director"?
you know, because np's don't practice medicine they practice "advanced nursing".....
never been able to figure out why if I suture or a doc does it's "practicing medicine" but if an np does it's "practicing advanced nursing".....

Same reason when a DO pops your back it's the practice of medicine and when a chiropractor does it it's the practice of chiropractics. Or when a physical therapist does it, it's the practice of physical therapy. How come when a doctor is giving out meds from his cabinet in a clinic it isn't the practice of pharmacy?

All I'm saying is that there is overlap.

 

[deleted6669]

Let's not get into exceptions rather than the norm. My point is that advanced practice nurses are prime for such leadership positions because the majority of a hospital's/healthcare facility's employees are generally nursing staff.

good point.
how about a pa who used to be(or still is) an rn. lots of them out there. it used to be that 33% of pa's were also rn's although that figure is lower now with more pa's coming from ems backgrounds.
there is an emergency facility in nc with an md medical director and a pa, rn administrative director so it can be done.
I always thought that as an rn, bsn the programs that made the most sense were the dual degree pa/np programs like uc davis. stanford used to have that option as well. I know a few folks with both certs. that is a sweet deal; 2 yrs of school and you graduate pa, fnp. you can work anywhere....

 

[deleted6669]

Emed, your friend jmj (the pain specialist) posted a while back about how he thought PAs could become independent after a period of time, and I tend to agree with him.

I don't see pa's ever becoming independent. I think what will happen over time is more pa's will choose to do residencies to meet credentialing requirements of various healthcare systems and hospitals. this will lead to a decrease in the ability of pa's to switch specialties over time. anyone will be able to do primary care right out of school but to do anything else will require a residency or prior experience.
states will continue to loosen supervisory requirements(some states already say "sponsorship" ) of pa's much like the np's who have "collaborating physicians" in those states where they don't practice independently but I don't ever see pa's working independently of physicians. those who want independent practice will go back to med school either by the traditional route or through a 3 yr bridge program(now that there is 1 I forsee many more soon).

 

[Denatured]

I agree that they'll never be independent. Just saying I agreed with jmj's thoughts. It will definitely not happen now that LECOM has a bridge (good for you guys BTW, bout time).

I see the future of PA moving towards the NC "supervision" model with just a Meeting every 6 months or minimal chart review.

I don't know if the residencies will become a thing of the future, at least not for a while. PAs are pretty stuck on their competency based education (which i applaud them for it). But I would hope that the future residencies would be more like St. Lukes and be open to NP and PA.

 

[PSYCHNP]

I found a link. I don't know if this is a typo or not. Anyhow, since we are all on the master's level we all know how to do our own research. All the best.

 

[PSYCHNP]

Yes, yes I agree with you all. With the powers that be independence for a PA seems to be a difficult barrier to overcome. I do greatly have respect for the educational prepareness of PAs. It is a rigorous program with high standards. Even to get into a program is tough. I have used several in my facilities and they are oustanding healthcare providers.

 

[Denatured]

Nurse Practitioner - Psychiatric. Join a rapidly growing company in an ... Nurse Practitioner, to work full time as the medical director of our rehab and ...
jobsearch.monster.com/.../Nurse-Practitioner/get-jobs-15.aspx - Similar

I found a link. I don't know if this is a typo or not. Anyhow, since we are all on the master's level we all know how to do our own research. All the best.

While I did find that link on google, the actual opening does not exist on monster.

 

[drift]

Nurse Practitioner - Psychiatric. Join a rapidly growing company in an ... Nurse Practitioner, to work full time as the medical director of our rehab and ...
jobsearch.monster.com/.../Nurse-Practitioner/get-jobs-15.aspx - Similar

I found a link. I don't know if this is a typo or not. Anyhow, since we are all on the master's level we all know how to do our own research. All the best.

research = google search...

I didn't know someone needed a masters for that. Point noted

 

[fab4fan]

I am glad you noted yourself that the NP would have 600 hours of clinicals as opposed to 300 by the PA. What about the theory? The advanced practice nurse would learn topics related to the his or her specialty each semester.

What you are also leaving out is that the NPs have had professional experience working on the pediatric nursing unit as RNs. You might ask yourself what is so great about being an RN? I have yet to see a PA as the director/manager of an ICU, Emergency room, psychiatric unit, medical sugical unit, hospital or even nursing home. Yes, RNs historically have held these leadership positions and an RN with a MSN or DNP is prime for such a position. Nursing staff make up the bulk of a hospital's employees. With 2.9 million RNs in the U.S., not to mention CNAs, and LPNs and I don't see a PA suited for these leadership positions. Like I said, the PA seems to be a great physician extender.

Here's where I get off the train. You have experience all right...working as a nurse, not a provider. Big difference.

 

[PSYCHNP]

Good point. If you really want the perfect scenario then go to medical or DO school and invest the money, time, and effort.

 

[Charles_Carmichael]

Let's be honest here. The only real reason why NPs/DNPs can practice independently in some states is not because they receive solid training. It's because of how ridiculously powerful the nursing lobby is.

I mean, 3rd year medical students have far, far superior training (both basic science and clinical hours) compared to both NPs/DNPs. You don't see them clamoring for independent practice though.

And PAs definitely have better training than NPs do. How is all the fluff in the NP curriculum going to help you clinically? How are all those statistics classes, business management classes, nursing theory classes, etc useful in the clinic? If you want to be an independent provider, spend time learning phys, path, pharm, pathphys, etc. It almost feels like I have better basic science training from my MCB major than what these NP/DNP curricula provide. Don't take fluff courses and tell us you're equivalent/superior to physicians (which is what the nursing leadership has been stating).

I've honestly lost all respect for all advanced practice nurses over the past year; you can thank the media and their leadership for that. And I will never ever hire NPs/DNPs in the future. I'll stick with PAs who, not only have superior training, , but also don't pretend they're equal to physicians.

/end rant.

 

[PSYCHNP]

Am I sensing a superiority complex here? This future physician states that one of the reasons he would not hire an NP is because of all the media attention they have received and because they think they are doctors. I want you all to take a look at the mindset of these folks (MDs) who will be in hiring positions. Look at the arrogance.

To all PAs that commented in this section earlier these are the oppressors you all have that are restricting your progress. Not the NPs. I guess PAs are fine and dandy as long as they can work and help you all make a buck.

That's ok doc, I don't think you have enough money to hire any self respecting PA or NP for that matter.

 

[Charles_Carmichael]

Am I sensing a superiority complex here? This future physician states that one of the reasons he would not hire an NP is because of all the media attention they have received and because they think they are doctors. I want you all to take a look at the mindset of these folks (MDs) who will be in hiring positions. Look at the arrogance.

To all PAs that commented in this section earlier these are the oppressors you all have that are restricting your progress. Not the NPs. I guess PAs are fine and dandy as long as they can work and help you all make a buck.

That's ok doc, I don't think you have enough money to hire any self respecting PA or NP for that matter.

Yes. I won't ever hire nursing midlevels because I don't like it when people pretend to be something they're clearly not. I wouldn't call this arrogance. Arrogance is what the nursing midlevels have when they keep stating that they're equal or even superior to physicians. Even though they have less than 10% of the training physicians receive.

I have nothing against PAs. Absolutely love them! They're well trained and don't have any silly notions that they're equal to physicians. I'm definitely looking forward to working together with PAs.

 

[rmsgolfer]

Am I sensing a superiority complex here? This future physician states that one of the reasons he would not hire an NP is because of all the media attention they have received and because they think they are doctors. I want you all to take a look at the mindset of these folks (MDs) who will be in hiring positions.

To all PAs that commented in this section earlier these are the oppressors you all have that are restricting your progress. Not the NPs. I guess PAs are fine and dandy as long as they can work and help you all make a buck.

That's ok doc, I don't think you have enough money to hire any self respecting PA or NP for that matter.

What kind of progress are you talking about? I feel that this is the twisted mindset a lot of mid levels have, that physicians are holding them back from (as you so put) progressing in medicine. No doctor is "oppressing" the advancement of any mid-level, they are simply telling them to do the job they are trained to do, no more no less.

Tell me what in your education has prepared you to "progress" far beyond your training if those pesky annoying doctors would get out of your way.

 

[deleted87716]

What kind of progress are you talking about? I feel that this is the twisted mindset a lot of mid levels have, that physicians are holding them back from (as you so put) progressing in medicine. No doctor is "oppressing" the advancement of any mid-level, they are simply telling them to do the job they are trained to do, no more no less.

Tell me what in your education has prepared you to "progress" far beyond your training if those pesky annoying doctors would get out of your way.

Surely you've heard of the Peter Principle.

 

[Boatswain2PA]

To all PAs that commented in this section earlier these are the oppressors you all have that are restricting your progress. Not the NPs. I guess PAs are fine and dandy as long as they can work and help you all make a buck.

Please do NOT try to make me out to be a "victim" of some "oppressors". If you want to take the role of the victim, then go for it, but I am certainly not one.

Oh, and yeah, I'll be "fine and dandy" to my SP ONLY as long as I can work and help him/her make a buck. That's what we are...physician assistants! PAs are NOT trained or educated to the level of physicians, which puts them in charge of the ship.

 

[drift]

PAs are cool, NPs suck

Now on to the point at hand. What can we do about these nurses trying to be doctors? I hate to just sit here and do nothing...

 

[mig26x]

the sad thing is that when a family member of the IOM personnel gets really sick all of them will want an MD/DO calling the shots. The poor/uninsured patients are the one's getting the non MD's/DO healthcare providers, which are usually the ones pretty sick per my experience.

 

[PICUPNP]

the healthcare field is so disgustingly against physicians. in one breath, they add on extra years to residency saying x amount of years is not enough to practice said field competently. ...this happened in a number of residencies. and then they say.. well nps can practice independently making medical decisions.. i repeat medical decisions.. without even attending medical school, without even taking the required science classes (as undergrads, thats as basic as you get) to understand truly what they are doing. And the people (PAs) who can truly step up to the plate to fill in the gap they leave out of the equation entirely. WTF? how can anyone look at the health care industry and take it seriously when this is what is going on.. NOt to mention the huge nursing shortages that is going on.. If nurses wanted to be doctors,... they should go to medical school..

There is a glut of nurses in the us right now. No shortage. Nurses have come out of the woodwork to go back to work since the econ0omy took a big hit.

 

[PSYCHNP]

Let's not use half truths. If one wants to become a DNP he or she has to go through the entire process starting from getting into an accredited RN program. There is a program which gives credit to MDs to become RNs more rapidly than traditional students. Foreign physicians usually go this route.

This is going to be my final post for a while. This goes out to all of the students out there. It was nice hearing from you all. You are a conscientious group. Some words to the wise that you may not find in any of the medical textbooks. Sometimes situations in life are not as they seem. When people give you things, sometimes it's wise to question it. Ask yourself, what do they have to gain? I know, I know I may sound cynical. Just ask yourself what do they have to gain? When they say they love PAs think about it. If I were an MD I would too. I can let them do all the "heavy lifting" while I build my practice and reap the benefits of business ownership. All the while they must remain subservient to me the MD. If I need extra work I can educate them on a part time basis at the local college. Maybe I could start my own school and make even more money on these guys. I could get away with this just by throwing them an occasional bone (I could give them credit for a year at a DO program or just tell them how smart they are. All the while knowing that the DO program would be full). Like they say, you are being bamboozled.

In the case of the relationship between PAs and MDs. MDs have one hand in your plate PAs, and one around your necks. You see yourselves, you see what they think of you from previous posts on this thread. I read this entire thread and it seems like PAs want to be more independent. Rns for the most part have remained silent on the issue.

Anyhow students, keep your heads up. This too shall pass. Any one of these career paths seem to be viable options. Just choose the one that works best for you.

 

[PSYCHNP]

I don't see pa's ever becoming independent. I think what will happen over time is more pa's will choose to do residencies to meet credentialing requirements of various healthcare systems and hospitals. this will lead to a decrease in the ability of pa's to switch specialties over time. anyone will be able to do primary care right out of school but to do anything else will require a residency or prior experience.
states will continue to loosen supervisory requirements(some states already say "sponsorship" ) of pa's much like the np's who have "collaborating physicians" in those states where they don't practice independently but I don't ever see pa's working independently of physicians. those who want independent practice will go back to med school either by the traditional route or through a 3 yr bridge program(now that there is 1 I forsee many more soon).

As you can see PAs would love to be liberated.

 

[zenman]

PAs are cool, NPs suck

Now on to the point at hand. What can we do about these nurses trying to be doctors? I hate to just sit here and do nothing...

You won't be able to do anything until you have distance and part-time education so that you can be more efficient with your time.

 

[danielmd06]

This is going to be my final post for a while.

Well, if you are going to spout fiery rhetoric that hinders rational discussion....then good riddance.

Physicians are restricting "progress" of NP's and PA's? What a silly notion. PA training is physician assistant training. No more. No less. Advanced nursing is advanced nursing. No more. No less. In no capacity is training for either sufficient to practice the art of medicine in an unsupervised capacity.

I'm sure you would love for this to be a fight for "progress" with the arrogant, superiority-complex ridden doctors. But you're wrong. If anything, we're protecting patients (the indigent and underserved to be exact..because THOSE are the individuals who will be cared for by mid-levels in these unsupervised roles) from governmental regulations that would lower the standards by which they are cared for. Who's the champion of the people, now? But that doesn't fit in to your concept of rich jerks "oppressing" mid-levels, does it?

Because your concept is wrong. Physicians may not have a good lobby, but we are still speaking the truth, if anyone out there cares to listen.

It is what it is.

 

[mig26x]

as a physician I dont feel qualified to practice as a qualified nurse when then do SOME nurses feel they can practice as a qualified physician with nurse training? It just blows my mind. And then if we complain is because of money issue but everytime nurses complain is because of patient safety.

Its sad.

 

[PSYCHNP]

The way you all describe DNP education is a half truth and you all know this.

Let's outline the educational pathway to becoming an advanced practice nurse. Let's say a nurse anesthetist:

1) Take prereqs to get into RN program
2) Be admitted into program many have long waitlists now
3) Go through the program with a high GPA so you could be admitted into anesthesia school
4) Take medical surgical, psych, peds, OB, and community health classes and do clinicals at the local teaching hospital
5) Pass the NCLEX exam
6) Apply to work in an ICU then be preceptored and trained (ACLS etc.) for several months prior to being allowed to practice as an ICU nurse
7) Work for a minimum of one year. Most schools prefer several prior to being admitted into school
8) Go through the anesthetist program for a minimum of 24 to I believe 36 months (Note: the program is full time, not online, and I would argue is much more rigorous than any PA program in the nation)
9) Sit the certification exam to become an anesthetist
10) Get a job at a teaching hospital where you will be preceptored some more
11) Apply to a DNP program where you will have to complete more clinical hours

Now Docs and PAs if this is the route you would like to take. You are more than welcome to attempt it. Good luck.

 

[PSYCHNP]

Anyhow one of the Med students stated this earlier:
After seeing what the typical DNP curriculum looks like, I don't plan to ever hire a DNP as well. Plus, if I'm going to be more qualified than a DNP as a 3rd year medical student, it's laughable (and rather frightening) that DNP's would ever try to gain the same practice rights as I will have as an attending.

Let's outline the educational pathway to becoming an advanced practice nurse. Let's say a nurse anesthetist:

1) Take prereqs to get into RN program
2) Be admitted into program many have long waitlists now
3) Go through the program with a high GPA so you could be admitted into anesthesia school
4) Take medical surgical, psych, peds, OB, and community health classes and do clinicals at the local teaching hospital
5) Pass the NCLEX exam
6) Apply to work in an ICU then be preceptored and trained (ACLS etc.) for several months prior to being allowed to practice as an ICU nurse
7) Work for a minimum of one year. Most schools prefer several prior to being admitted into school
8) Go through the anesthetist program for a minimum of 24 to I believe 36 months (Note: the program is full time, not online, and I would argue is much more rigorous than any PA program in the nation)
9) Sit the certification exam to become an anesthetist
10) Get a job at a teaching hospital where you will be preceptored some more
11) Apply to a DNP program where you will have to complete more clinical hours

Now Docs and PAs if this is the route you would like to take. You are more than welcome to attempt it. Good luck.[/QUOTE]