NPs can now do dermatology residencies

[werd]

I like the show Reno911. Its pretty funny. As you can see though my points were not directed at Dermatologists nor any other specialty. I defer to their expertise. My biggest issue has always been the way in which some have been degrading the nursing profession as a whole. Calling into question the IQ and intelligence of those who work with you is not the best team building strategy. I have never even seen the video that started this whole debate, but I was upset by the ways in which nursing as a whole was being belittled.

it's probably almost too easy for you to inflame med students and premeds by challenging their supposed turf. in my experience, np's function on the level of pgy-1 residents, plus or minus about a year - just fine in many situations but need oversight if things are complicated. a little real world experience working with nps and other physician extenders gives one a clearer role of where things stand.

to the future md's - no one is legitimately challenging you for your future job. to the np's - no one (with experience) is saying you're not good at patient care. i'll end by saying the inflammatory tone of this thread reflects poorly on all of us. werd.

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[Makati2008]

As a midlevel,
I would like to suggest that the moderators politely BAN THIS GUY! He is starting a flame war with the NP/DNP vs MD/DO. As a PA, I personally respect some NP's but when I hear the NP's BLATANTLY admit that oh I don't know how to admit patient's let the PA do it,can't read a basic EKG, don't know how to suture fresh out of school(had an NP with this problem she was let go for other reasons...), then please don't compare our education(MLP) being above the doctors.

I work with many good doctors and it is NP's like this person that makes some attending dislike us.

Again, I implore the moderators to ban this guy.
And to DNPGATOR-I start medical school this year. Your quite arrogant why don't you come and join me in the class(Stop the excuses about you don't want too!). And since you know so much you won't be nearly as scared as me.....PA's/NP's flunk out of medical school every year(only a few but it does happen and I actually talked to a few)

 

[Slack3r]

it's probably almost too easy for you to inflame med students and premeds by challenging their supposed turf. in my experience, np's function on the level of pgy-1 residents, plus or minus about a year - just fine in many situations but need oversight if things are complicated. a little real world experience working with nps and other physician extenders gives one a clearer role of where things stand.

to the future md's - no one is legitimately challenging you for your future job. to the np's - no one (with experience) is saying you're not good at patient care. i'll end by saying the inflammatory tone of this thread reflects poorly on all of us. werd.

DNPs can practice primary care with no MD supervision whatsoever in 28 states. How is that not usurping the job responsibilities of physicians?

 

[NYRN]

DNPs can practice primary care with no MD supervision whatsoever in 28 states. How is that not usurping the job responsibilities of physicians?

This is true, but in these states, NP's without an collaborating MD are not eligible for medicare part B reimbursement. Nobody is going to open a practice when they aren't getting paid. I have no plans of ever opening a practice, so it doesn't bother me in the least.

 

[NYRN]

As a midlevel,
I would like to suggest that the moderators politely BAN THIS GUY! He is starting a flame war with the NP/DNP vs MD/DO. As a PA, I personally respect some NP's but when I hear the NP's BLATANTLY admit that oh I don't know how to admit patient's let the PA do it,can't read a basic EKG, don't know how to suture fresh out of school(had an NP with this problem she was let go for other reasons...), then please don't compare our education(MLP) being above the doctors.

I work with many good doctors and it is NP's like this person that makes some attending dislike us.

Again, I implore the moderators to ban this guy.
And to DNPGATOR-I start medical school this year. Your quite arrogant why don't you come and join me in the class(Stop the excuses about you don't want too!). And since you know so much you won't be nearly as scared as me.....PA's/NP's flunk out of medical school every year(only a few but it does happen and I actually talked to a few)

NP's like this give us all a bad name. I am starting NP school now with a few years of experience behind me. NP's like the one you mentioned go to fast track programs and have no real experience behind them so they don't know jack.

I work with some residents who were PA's first, and I have to say, they are top notch. Its really a pleasure working with them. Best of luck to you.

 

[VA Hopeful Dr]

Listen SLOPO, focus!

Whatever it is you will be an attending in 3 years don't mean jack

If we don't do this together we will go down divided

This ain't about regulating midlevel independent practice in non-primary specialties only,

dis is bout regulatind de practice of MEDICINE of midlevels!

Comprende?

You can argue back and forth all you want, I DON GUT TINE FOR DIS!!

You're definitely not getting it. Once a non-MD gets new practice rights, it is practically impossible to get that taken away from them. It sucks, but that's just the way it is. I'm not going to put my time and money into something that will not work. You can argue that practically impossible isn't truly impossible and good luck to you with that.

If a state doesn't have independent practice rights, that's great. We can work there. If a state does, I'm not going to mess with that.

 

[Dr Oops]

This is true, but in these states, NP's without an collaborating MD are not eligible for medicare part B reimbursement. Nobody is going to open a practice when they aren't getting paid. I have no plans of ever opening a practice, so it doesn't bother me in the least.

They can just lobby some more, tell medicare how they do the same thing as doctors and are trained just as well and get the reimbursement.

 

[MOHS_01]

Here's a good one for you -- given the formula by which MC rates (and thus, most private insurance rates) are calculated -- what effect do you believe this influx of nurses/doctorates will have on physician reimbursement rates even in the absence of expanded authority?

 

[Slack3r]

Here's a good one for you -- given the formula by which MC rates (and thus, most private insurance rates) are calculated -- what effect do you believe this influx of nurses/doctorates will have on physician reimbursement rates even in the absence of expanded authority?

GOING DOWN, BABY!

 

[DermViser]

Yes or no? Do the MD's believe the DO's are equally educated and had to survive the same rigorous training or do they feel that degree is second best?

DNPgator, pssst....your ignorance is showing. DOs enter the exact same residency programs as MDs - as many of them actually train in allopathic residencies. That's the difference Debra Shelby...I mean DNPgator.

 

[mig26x]

DNPgator, pssst....your ignorance is showing. DOs enter the exact same residency programs as MDs - as many of them actually train in allopathic residencies. That's the difference Debra Shelby...I mean DNPgator.

it will be funny if noctor shelby is dnpgator!! LOL.

and to answer dnpgator (I went to UF too) question, nope. DO's and MD's are equal. We and DO's go through rigorous training during med and do school and then residency training, in fact in my IM program we have a good number of DO's and they are treated as equal because we know the education is equal.

 

[FlowRate]

This thread has taken a really depressing turn. I don't mean to flame in particular, but the NP's who posted in this thread recently have reminded me how b*tchy some nurses can be, especially when they want to band together and get a doctor in a ton of trouble. Heck, everyone knows this, but their posts are downright scary. "Treat us as equals or we'll get you in trouble!!!"

 

[NYRN]

After reading these posts on here, I have been looking more into these issues to educate myself. Neither I or any NP/NP student I know agree with these TV DNP's and are looking to ge involved because we fear that these rogue NP's are going to ruin our practice, nor do we want to be forced into breaking collaboration in order to get paid for services.

I really think there are 2 different issues here. These rogue NP's on TV are looking for equal scope of practice in addition to independent practice. That is what I think is the part that endangers patients in many cases. The vast majority of NP's who want independ. practice, are NOT looking for equal scope of practice to MD's. PA's are practicing under the supervision of MD's so if they F up, you are responsible. NP's are working collaboratively but are LIP's, so the MD is not responsible for the actions of the NP if the NP does not refer to him/her and something happens even if they are in collaborative practice together.

Most of the NP's who want independent practice actually do want to work with MD's. The NP's who want independ. practice but NOT equal scope I don't think would be objectionable to many MD's if they can see what they are really seeking. One example they gave is an NP wants open up a preventitive healthcare practice within a cardiologist office focusing on maintaining health for patients with cardiac issues. The MD is the one managing the cardiac issues, and the NP is working with the patients on health promotion/maintance in compliment with the meds and treatment they are recieving from the MD. The MD is not responsible for the NP's actions (this is as of current standards) so if it were the case that the NP did something to harm a patient, the MD cannot be sued. The MD would have the choice to allow this NP to open up an independ. practice and collect rent from him/her in his/her office just as MD's do now sharing office space. If the MD did not agree with the ideas of the NP's practice, he/she does not have to allow them there. In reality, the MD and the NP would be working together, even if thier business interests are seperate.

Regardless of whether or not the state is an independ. practice state or requires collaboration, the NP scope of practice is the same. The definition of the training of primary care/family care NP is to diagnose and treat COMMON illnesses and problems. A family/prim care MD is trained to treat common and complex illness and problems. These NP's who are pushing the boundaries should face the same liability and pay the same premiums as MD's do. When they miss things and cause injury, they are going to make my premiums go through the roof even if I am not practicing as they are.

I looked at the website of NYSNA which a large nursing union representing NY state, NJ and other surrounding states. This group has a strong lobby and we have been successful passing laws. You have to be a member to see the policital agenda, and what I found was that there were nothing about pushing for independent practice or for expanding scope of practice for NP's. The issues that they are pushing for are things related to nursing and patient care such as banning mandatory overtime (which did pass), making assault on nurses while at work a felony, establishing nurse-patient ratios, reducing workplace injuries and making the bachelors degree a minimum degree for RN practice.

 

[NYRN]

This thread has taken a really depressing turn. I don't mean to flame in particular, but the NP's who posted in this thread recently have reminded me how b*tchy some nurses can be, especially when they want to band together and get a doctor in a ton of trouble. Heck, everyone knows this, but their posts are downright scary. "Treat us as equals or we'll get you in trouble!!!"

I never said that, so I hope your not referring to me. I don't want to get anyone in trouble. I have also said that I help residents fix the problem before the attending sees it or before the nurses on the floor see it and go to the attending complaining about you. Most often if your attending gets involved and yells at you, its because another attending has a complaint. Work with me, and I will make your life 100x easier. Work against me, and I will not go out of my way to help you.

 

[N-Surge]

I do not see how it is a General Residency issue and quite frankly it should probably be locked.

 

[exPCM]

I do not see how it is a General Residency issue and quite frankly it should probably be locked.

Good to see the Orwellian thought police are so alive and well on SDN. So you do not think it is a residency issue.
We have many real physicians (MDs and DOs) doing taxing residency programs in many different specialties.
Now we have non-physicians doing much less rigorous and shorter duration endeavors that they now call a "residency".
This issue illustrates how non-physician wannabes are taking the term "residency program" and using it in order to imply some equivalency to physician residency training programs.
These DNP "residencies" are in no way equivalent to physician residency programs in intensity, substance, knowledge level, etc.
Now we have another activist moderator wanting to quash discussion and lock a thread.
This is the flaw in SDN IMO.
We have moderators with their own agendas locking and moving threads and inhibiting free discussion, often with little or weak justification.
Maybe I will be sanctioned or suspended again for posting this. I will continue to not be afraid to discuss controversial issues.
Here you have an independent nurse practioner in Scottsdale AZ running a derm practice doing cosmetic dermatology (botox, restylane, and laser dermatology):
http://www.ultrasmoothskin.com/
I think the agendas of NPs are an important issue to face for both residents and attendings.
I also think that some of our calls and emails may have some effect - an example being the taking down of the USF DNP dermatology video.
List of Independent NP practices in AZ: http://aznpconnection.netfirms.com/indyaznpspec.pdf - Interesting we have NP derm, cardiology, neurology, fp, surgery, pain management, psychiatry, etc.

 

[bassstimme1]

Here you have an independent nurse practioner in Scottsdale AZ running a derm practice doing cosmetic dermatology (botox, restylane, and laser dermatology):
http://www.ultrasmoothskin.com/
I think the agendas of NPs are an important issue to face for both residents and attendings.
I also think that some of our calls and emails can have some effect - an example being the taking down of the USF DNP dermatology video.
List of Independent NP practices in AZ: http://aznpconnection.netfirms.com/indyaznpspec.pdf - Interesting we have NP derm, cardiology, neurology, fp, surgery, etc.

Some of the more sickening highlights from those links are:
from the first one:
NPs specialize in many

areas, including
Acute Care
Adult Health
Family Health
Gerontology Health
Neonatal Health
Oncology
Pediatric/Child Health
Psychiatric/Mental Health
Women's Health​

NPs also often practice in sub-specialty areas such as:
Allergy & Immunology
Cardiovascular
Dermatology
Emergency
Endocrinology
Gastroenterology
Hematology & Oncology
Neurology
Occupational Health
Orthopedics
Pulmonology & Respiratory
Sports Medicine
Urology​

More and more people are choosing NPs as their primary, acute and/or specialty

healthcare provider. In addition to being top-notch healthcare providers, NPs deliver a

unique blend of nursing and medical care. They provide comprehensive, personalized
health education and counseling. NPs assist patients in making better lifestyle and​

health decisions.​

from the second link:
Tyrrell, Ann NP/CRNFA​

Maricopa Surgical Associates​

PO Box 2116​

​

Sun City, AZ 85372​

602-261-9272​

Vascular/Endovascular/Orthopedic/General Surgery
She's a super Noctor! Unlike you scrub physicians, she's an orthopod, general and vascular surgeon all rolled into one. I bet she can even operate on multiple patients at the same time.
And lest you think neurosurgery is safe:
White, Nancy NP​

Nancy White, NP-C, CRNFA

Phoenix and Surrounding Hospitals​

Phoenix, AZ​

602-279-1384​

Neurosurgery, First Assist - Pager (602) 222-7961​

 

[NYRN]

If its really about pt safety, than our efforts should be to fight against people like this. http://www.wired.com/wiredscience/2009/10/botox-without-prescription/ This woman is neither an MD/NP and she is able to purchase botox legally and developed a youtube video for women on how to administer themselves.

I really don't see what the big deal is about this spa. Here in NY there are tons of places that call themselves medi-spas, that have no doctor or even nurse on premises or affiliated with them at all. An MD is paid a fee to come in and give botox when requested if that spa offers it, but he/she is not overseeing what is going on there. Having some practitioner on premises I think is safer than having none at all. I would be more against calling a place a "medi"-spa with no real MD or NP in charge than at the very least having a licensed NP there.

If the fight against NP's is partially based on the belief that they are forming their own organizations to become "board certified" and confuse the public, than I think it would be hypocritical to fight them and not fight this: http://www.bewiseaboutbeauty.org/learn/myth.html#m1
Optho, ENT and dermatology performing advanced plastics procedures. This patient info site along with others says that members of the American Academy of Cosmetic Surgery are trained specifically to perform cosmetic surgery and Plastic's board certif. MD's are trained in correcting congenital deformities and such. AACS is a perfect example of a group forming their own way of becoming "board certified". I'm sure the MDs that spent years in plastic surgery residency would disagree with the AACS.

Again, I think the fight against NP's who are looking to replace MD' is legitimate. Those few NP's are attempting to do so in primary care, not specialty areas. However, the more I look into these specialty training programs, the more I understand the purpose for which they are designed. The specialty ones are designed to further train the NP in the specialty they are want, so they will gain skills in order to work in those area in collaboration with MD's. It would be out of the scope of practice and illegal for any of these NP's trained in specialty areas to open a practice alone. PA's have been doing "residencies" for years, this is nothing new.

I copied this quote from the previous post on this thread. I see how you can be taking it the wrong way. From what I have been reading, these practices the NP's are setting up are not intended to replace MD's. "In addition to being top-notch healthcare providers, NPs deliver a unique blend of nursing and medical care. They provide comprehensive, personalized health education and counseling. NPs assist patients in making better lifestyle and health decisions"

I'll give you an example of what this means, and if you still disagree with it that's OK.

An NP with a fellowship in diabetes care opens up an independent practice. This practice may be in rented space w/in an MD office or may have a free standing office. The endocrinologists/cardiologist/internal medicine MD's refer the patients there, so even though the NP is practicing alone, he/she is still working with the MD's. The care the patient is getting from the NP is focused on lifestyle changes related to diabetes, not primary management of the patient. MD's do not have the time to spend on this type of care with the patient as it is. I don't see how this type of care given by both the NP and MD is dangerous for the patient.

Other fellowships such as critical care, emergency medicine are just extra training to help them work in these areas. We already have plenty of PA's and NP's working ER as it stands, especially in non-teaching hospitals. The relationship b/t the MD's and midlevels we have now has been working out well, and I don't see that changing.

 

[Dr Oops]

An NP with a fellowship in diabetes care opens up an independent practice. This practice may be in rented space w/in an MD office or may have a free standing office. The endocrinologists/cardiologist/internal medicine MD's refer the patients there, so even though the NP is practicing alone, he/she is still working with the MD's. The care the patient is getting from the NP is focused on lifestyle changes related to diabetes, not primary management of the patient. MD's do not have the time to spend on this type of care with the patient as it is. I don't see how this type of care given by both the NP and MD is dangerous for the patient.

Do you really need any more training or practice rights to tell people to exercise and eat right?

 

[NYRN]

Do you really need any more training or practice rights to tell people to exercise and eat right?

I'm just going to use the diabetes NP as an example. An advantage of having an NP over an RN or dietician would be, the prescriptive privleges could take care of things such as arranging for home care if needed, ordering supplies such as syringes and glucometers, giving referrals to other specialists such as dieticians if needed.

I think we are all in agreement that patients are for the most part not following diet/lifestyle guidelines that MD's are recommending. Part of the reason is that MD's do not have the time during an office visit to really get into the importance and "how-to's" of this. An NP with additional training in diabetes would have a better understanding of diabetes (compared to a non-specialty trained NP, not as compared to the MD) and what/why the MD is prescribing meds/treatments. The NP could use this knowledge to work with the patient on many levels to improve compliance with health maintainance and the treatment the MD has designed for them.

I think if the MD's/med students here understood that this is what 99.9% of the NP's seeking specialty training are looking to do (NOT to take over MD roles), I don't think anyone would see the NP's as a threat.

 

[jbz24]

What advantage is there to hire an NP over a PA? Let the NPs stay in nursing, that is what they went to school for.

 

[NYRN]

What advantage is there to hire an NP over a PA? Let the NPs stay in nursing, that is what they went to school for.

One advantage over having an NP over a PA is that the MD does not have to supervise the NP. The MD is not responsible in any way for the NP since he/she is not working under his/her license. The MD can refer to this NP and not have to worry about billing or legal issues. More likely than not, the NP and MD's referring patients to him/her already have a good working relationship and the MD's trust the care they are given. Patients may seek out the NP's care on their own in addition to the care they are getting from their MD. Nursing and advanced practice nursing are not the same thing. If you are going to fight this fight, you have to know what you are talking about and not make ignorant statements.

 

[jbz24]

One advantage over having an NP over a PA is that the MD does not have to supervise the NP. The MD is not responsible in any way for the NP since he/she is not working under his/her license. The MD can refer to this NP and not have to worry about billing or legal issues. More likely than not, the NP and MD's referring patients to him/her already have a good working relationship and the MD's trust the care they are given. Patients may seek out the NP's care on their own in addition to the care they are getting from their MD. Nursing and advanced practice nursing are not the same thing. If you are going to fight this fight, you have to know what you are talking about and not make ignorant statements.

That is a DISadvantage to me, not an advantage.

 

[J1515]

I think we are all in agreement that patients are for the most part not following diet/lifestyle guidelines that MD's are recommending. Part of the reason is that MD's do not have the time during an office visit to really get into the importance and "how-to's" of this.

Wrong. Patients don't follow guidelines because they don't take responsibility for themselves. It has nothing to do with not knowing the consequences or not knowing what to do. Give me a break. Everyone knows smoking kills you. Doesn't seem to stop many people, does it? Hell, I've got an uncle with emphysema who needs daily O2. He brings the tank outside with him so he can light up a cigarette. You can sit there with patients for over 30 mins discussing their diet, finger stick diaries, the consequences of not improving their habits, answering questions, etc.. I've done this and so have my colleagues. It means nothing. Even telling a patient they will die usually won't make a difference as long as they're asymptomatic. Yet we continue to spend time doing this because it's the right thing to do and might make a difference in 1/30 patients. Society has a "it won't happen to me but if it does, the doctors can just fix it or I'll sue" attitude. You can talk to a patient until your lips fall off. Dr. Nurse DNP, NP, RNP, CRNA, BSN, PhD, ANA, FNP, AANC will not make a difference. They will hit the nearest McDonalds the second they leave your office. Yes, I've even seen some doctors be **nice** to the patients and appear to make a connection with them during their visit, only to followup 3 months later with daily finger stick readings in the 300s.

Nobody with half a brain is buying into the propaganda that there is some kind of alternate universe where mind, body, and spirit are essential to treating a patient holistically and comprehensive care treats the patient instead of the disease blah blah blah. Cut the crap. Physicians do all the things NPs claim are unique to the nursing world except with a better knowledge base and reasoning as to why things are being done. Give me a PA over an NP anyday.

It's interesting how you came in here at first and tried to get on everyone's good side, agreeing with everyone that this whole DNP movement is wrong and even taking a few jabs at your own profession. Once you saw people agreeing with you and patting you on the back for being a "good one", the tone of your posts changed. Now you are trying to get us to put this issue on the backseat and focus on tort reform. I believe on another recent post you also tried to convince us that we should be worrying more about PAs encroaching on our scope of practice more than NPs. Nobody's buying it. Your attempt has failed.

 

[wine is good]

Wrong. Patients don't follow guidelines because they don't take responsibility for themselves. It has nothing to do with not knowing the consequences or not knowing what to do. Give me a break. Everyone knows smoking kills you. Doesn't seem to stop many people, does it? Hell, I've got an uncle with emphysema who needs daily O2. He brings the tank outside with him so he can light up a cigarette. You can sit there with patients for over 30 mins discussing their diet, finger stick diaries, the consequences of not improving their habits, answering questions, etc.. I've done this and so have my colleagues. It means nothing. Even telling a patient they will die usually won't make a difference as long as they're asymptomatic. Yet we continue to spend time doing this because it's the right thing to do and might make a difference in 1/30 patients. Society has a "it won't happen to me but if it does, the doctors can just fix it or I'll sue" attitude. You can talk to a patient until your lips fall off. Dr. Nurse DNP, NP, RNP, CRNA, BSN, PhD, ANA, FNP, AANC will not make a difference. They will hit the nearest McDonalds the second they leave your office. Yes, I've even seen some doctors be **nice** to the patients and appear to make a connection with them during their visit, only to followup 3 months later with daily finger stick readings in the 300s.

Nobody with half a brain is buying into the propaganda that there is some kind of alternate universe where mind, body, and spirit are essential to treating a patient holistically and comprehensive care treats the patient instead of the disease blah blah blah. Cut the crap. Physicians do all the things NPs claim are unique to the nursing world except with a better knowledge base and reasoning as to why things are being done. Give me a PA over an NP anyday.

It's interesting how you came in here at first and tried to get on everyone's good side, agreeing with everyone that this whole DNP movement is wrong and even taking a few jabs at your own profession. Once you saw people agreeing with you and patting you on the back for being a "good one", the tone of your posts changed. Now you are trying to get us to put this issue on the backseat and focus on tort reform. I believe on another recent post you also tried to convince us that we should be worrying more about PAs encroaching on our scope of practice more than NPs. Nobody's buying it. Your attempt has failed.

Exactly. I called her on it in another thread. She's trying to put the blame on PAs now. Very slippery.

That's why we can't be complacent with these people. Wolf is sheep clothing. The fact is that however a nurse may try to side with you, in their heart, they have to back their own, understandably so, because, they walk in the same shoes. A nurse will NEVER understand what it's like to be a resident and physician until they WALK in our shoes. First do a straight 24 hour call without sleep, be responsible for the decision making of a critically ill pt when you are tired, then you know what I know. Till then, step off.

 

[JaggerPlate]

Exactly. I called her on it in another thread. She's trying to put the blame on PAs now. Very slippery.

That's why we can't be complacent with these people. Wolf is sheep clothing. The fact is that however a nurse may try to side with you, in their heart, they have to back their own, understandably so, because, they walk in the same shoes. A nurse will NEVER understand what it's like to be a resident and physician until they WALK in our shoes. First do a straight 24 hour call without sleep, be responsible for the decision making of a critically ill pt when you are tired, then you know what I know. Till then, step off.

Dude, haven't you heard? The only difference between a NP and a DO/MD is the salary. They definitely go through intense residencies. I have friend who works side by side with plastic surgeons, dermatologists, MOHS surgeons, etc, who completed a rigorous residency in nursing dermatology, and, in doing so, has earned the right to be called Dr Noctor, BC dermatologist in a clinical setting.

/sarcasm

 

[core0]

One advantage over having an NP over a PA is that the MD does not have to supervise the NP. The MD is not responsible in any way for the NP since he/she is not working under his/her license. The MD can refer to this NP and not have to worry about billing or legal issues. More likely than not, the NP and MD's referring patients to him/her already have a good working relationship and the MD's trust the care they are given. Patients may seek out the NP's care on their own in addition to the care they are getting from their MD. Nursing and advanced practice nursing are not the same thing. If you are going to fight this fight, you have to know what you are talking about and not make ignorant statements.

Actually the MD is responsible for the NP just as they are for PAs. First of all most states (>2/3) require a supervision or collaboration. This means that they are responsible for the actions of the NP. Also if the physician employs the NP they are responsible for the actions of the NP just as any business owner. I didn't bother to check is not a valid defense in the court of law.

In addition Medicare and the JC require that all patients admitted to the hospital be under the care of a physician. When NPs and PAs are credentialed a physician must attest to their skill and be willing to be responsible for their actions.

If you look at malpractice claims, they are going up for NPs and PAs. In the past it was rare for a PA or NP to be involved. Traditionally patients have gone after the physician who presumably had deeper pockets. Now with tort reform PAs and NPs are frequently brought into lawsuits along with the physicians.

On the other hand PAs have a scope of practice that far exceeds NPs (depending on the states willingness to enforce NP scope of practice).

So yes there is a reason to hire NPs over PAs. If you are lazy and don't care about your malpractice exposure.

David Carpenter, PA-C

 

[NYRN]

Nobody called me on anything. I dare anyone here to quote me where I ever said:

DNP's should have the same privledges as MD's or that the edu/training is equivalant, that an NP fellowship is equal to MD residency or that DNP's should be called doctor in clinical practice. Saying that nurses are trying to work with doctors and get along and taking as someone who is looking to stab you in the back is ridiculous. Paranoid much?

I brought up the PA thing because in REAL LIFE, I have come across many PA's feel they could replace an MD. I have yet to meet an NP that feels that way. This of course does not represent ALL PA's. but to sit back and think that ALL PA's are happy in thier role, you are mistaken. Either you are anti-midlevel, or you are anti-nurse. If you are confident that the public will see the value of having an MD over a PA/NP, than you should not feel threatened at all.

NP's were NEVER under the supervision of MD's. PA's practice under MD's license, NP's who are LIP's do not. If the PA F's up, the MD is responsible. Even in a collaborative practice, the MD is NOT responsible for the NP's actions. This has been proven in court cases over the years. Collaboration does NOT mean supervision. LIP as defined by the joint commission http://www.wapa.org/ppc/ppc28_Clarification of LIP.pdf This addresses PA's under the direction of MD's. The reason TJC addressed this in the first place was because in many hospitals, PA's were not allowed to put in orders for certain things such as restraints that NP's were allowed to do. This clarification now allows MD's to delegate this task to PA's under his/her order. The scope of practice of a PA is not above an NP. The difference is, a PA can change specialty at any time, where an NP is allowed more freedom because they trained in a certain area.

I work with awesome PA's at my hospital. I am in no way anti-PA. In fact, the PA's I work with say that because of the many restrictions on them in the hospital settings, some would have rather gone to NP school.

 

[FlowRate]

This is silly. Reading doublethink and propaganda gets really painful.

 

[Dr Oops]

I brought up the PA thing because in REAL LIFE, I have come across many PA's feel they could replace an MD. I have yet to meet an NP that feels that way.

Thats because theyre all going on tv.

 

[NYRN]

Thats because theyre all going on tv.

Yup the same 3 NP's going on TV represent the thousands of NP's out there. If you are saying that those who go on TV represent the profession they come from, than people should believe what they see on TV related to MD practice. Let's see what has been in the news lately:

Michael Jackson's MD gets paid $300k a month to be his doctor. He kills him using propofol which he should have never given him in the first place, then tries to cover it up before he even attempts resuscitation.

The well known ped MD who was molesting kids that was recently arrested in NY. Some of these kids were as young as 3 months old.

MD's who are going to jail in Florida for setting up pill mills and patients are overdosing and dying left and right.

Is it fair that people will see this on the news and assume you fit in to one of these categories? None of the MD's I know do, and I know a whole lot of em.

 

[jbz24]

Yup the same 3 NP's going on TV represent the thousands of NP's out there. If you are saying that those who go on TV represent the profession they come from, than people should believe what they see on TV related to MD practice. Let's see what has been in the news lately:

Michael Jackson's MD gets paid $300k a month to be his doctor. He kills him using propofol which he should have never given him in the first place, then tries to cover it up before he even attempts resuscitation.

The well known ped MD who was molesting kids that was recently arrested in NY. Some of these kids were as young as 3 months old.

MD's who are going to jail in Florida for setting up pill mills and patients are overdosing and dying left and right.

Is it fair that people will see this on the news and assume you fit in to one of these categories? None of the MD's I know do, and I know a whole lot of em.

The problem is that even if you don't feel represented by those three on TV, there are many more that do. Read some of the comments by NPs from the article that the OP posted. Some of it is ridiculous. You may be trying to be the "voice of reason" (which you aren't either), but there are countless of NPs who want just what you say they don't.

 

[NYRN]

The problem is that even if you don't feel represented by those three on TV, there are many more that do. Read some of the comments by NPs from the article that the OP posted. Some of it is ridiculous. You may be trying to be the "voice of reason" (which you aren't either), but there are countless of NPs who want just what you say they don't.

Show me proof that these NP's are representing most of the NP's working today. I nor anyone else I know shares these beliefs. I would think that if there were so many people out there who wanted what these TV NP's want, I would have heard about it from other nurses/NP's or even MD collegues.

The union I belong to has a powerful lobby, and have been successful in getting patient safety laws passed. They mainly represent RN's but they do also represent NP's. I have not yet seen any legislative action brought forth to expand the role of NP's. All the issues they are pushing for deal with patient safety issues. Nursing unions are the groups with the biggest influence, and if my union isn't pushing for what you say they are, I'm pretty sure its not as big a problem as you think.

 

[Dr Oops]

Show me proof that these NP's are representing most of the NP's working today. I nor anyone else I know shares these beliefs. I would think that if there were so many people out there who wanted what these TV NP's want, I would have heard about it from other nurses/NP's or even MD collegues.

The union I belong to has a powerful lobby, and have been successful in getting patient safety laws passed. They mainly represent RN's but they do also represent NP's. I have not yet seen any legislative action brought forth to expand the role of NP's. All the issues they are pushing for deal with patient safety issues. Nursing unions are the groups with the biggest influence, and if my union isn't pushing for what you say they are, I'm pretty sure its not as big a problem as you think.

THen why is every single NP required to get a DNP by 2015?

 

[NYRN]

THen why is every single NP required to get a DNP by 2015?

That is not true. These NP's want the DNP degree to be the minimum degree for advanced practice, but they do not intend in making it a dead on requirement by 2015. Nursing groups have been trying to make the BSN the minimum for nursing practice for probably 15 years now and that has not happened. Most NP's don't want to get a DNP because it serves no purpose as it is, unless they are planning on going into nursing ed or taking jobs as nurse clinical instructors.

 

[J1515]

I brought up the PA thing because in REAL LIFE, I have come across many PA's feel they could replace an MD. I have yet to meet an NP that feels that way. This of course does not represent ALL PA's. but to sit back and think that ALL PA's are happy in thier role, you are mistaken.

PAs don't have a movement right now to expand their scope of practice, NPs do. Whether you agree with the movement or not is irrelivant. Do not expect physicians to sit back and watch or think this is all rubbish just because you've "never met an NP who wants expanded priviliges."

Again, your plan of becoming everyone's friend and then slowly trying to "show us the light" has been unsuccessful, so I'm not sure what you're still doing here.

 

[Socrates25]

In addition Medicare and the JC require that all patients admitted to the hospital be under the care of a physician. When NPs and PAs are credentialed a physician must attest to their skill and be willing to be responsible for their actions.

This is not true. Mary Mundinger's DNP program at Columbia routinely advertises their ability to admit patients to the hospital, where they are followed by NPs with no MD oversight or "collaboration."

 

[Bombesin]

I've been lurking on here for a few days reading the banter and thought I'd inject some humor into the conversation. Forgive me if this was already posted, but the first part makes me laugh at all the absurdity:

http://www.youtube.com/watch?v=i6cwcIPf9Xs&feature=related

 

[core0]

snip

NP's were NEVER under the supervision of MD's. PA's practice under MD's license, NP's who are LIP's do not. If the PA F's up, the MD is responsible. Even in a collaborative practice, the MD is NOT responsible for the NP's actions. This has been proven in court cases over the years. Collaboration does NOT mean supervision. LIP as defined by the joint commission http://www.wapa.org/ppc/ppc28_Clarification of LIP.pdf This addresses PA's under the direction of MD's. The reason TJC addressed this in the first place was because in many hospitals, PA's were not allowed to put in orders for certain things such as restraints that NP's were allowed to do. This clarification now allows MD's to delegate this task to PA's under his/her order. The scope of practice of a PA is not above an NP. The difference is, a PA can change specialty at any time, where an NP is allowed more freedom because they trained in a certain area.

I work with awesome PA's at my hospital. I am in no way anti-PA. In fact, the PA's I work with say that because of the many restrictions on them in the hospital settings, some would have rather gone to NP school.

I'm not sure why you brought up the LIP issue but if you read the JC definition its very clear that neither PAs or NPs are considered LIPs.
"Licensed independent practitioner: Any practitioner permitted by law and by the organization to provide care and services, without direction or supervision, within the scope of the practitioner license and consistent with individually assigned clinical responsibilities. When standards reference the term “licensed independent practitioner,” this language is not to be construed to limit the authority of a licensed independent practitioner to delegate tasks to other qualified health care personnel (for example, physician assistants and advance practice registered nurses) to the extent authorized by state law or a state’s regulatory mechanism or federal guidelines, and organizational policy."

The clarification allows the physician to delegate to both PAs and NPs.

As far as NPs were never under the supervision of MDs, I would recommend you review the history of the NP. The first NPs actually practiced under delegated physician authority as there was no practice act for NPs. The concept of the "independent NP" is relatively new (late 80's early 90's). There are still more than 10 states that require physician supervision of NPs.

As far as scope, I would challenge you to show me where NPs are allowed more freedom within an area. The only limit to PA scope is the physicians scope and what the physician allows the PA to do. Contrast this with the limitation on NP practice concerning surgery, patient population by age and setting (depending on state enforcement).

David Carpenter, PA-C

 

[NYRN]

PAs don't have a movement right now to expand their scope of practice, NPs do. Whether you agree with the movement or not is irrelivant. Do not expect physicians to sit back and watch or think this is all rubbish just because you've "never met an NP who wants expanded priviliges."

Again, your plan of becoming everyone's friend and then slowly trying to "show us the light" has been unsuccessful, so I'm not sure what you're still doing here.

MD's are entitled to their own opinion. I wouldn't expect any group to sit there if another group was trying to push them out. My plan is to befriend you and then change your minds? I don't think so. Whether you like it or not, nurses and NP's are important to patient care. We should be working TOGETHER not against each other. I came here to engage in intellegent discussion regarding healthcare and to try to see if NP's and MD's could come to some sort of compromise. Apparently, people are more interested in being nasty and holding on to false beliefs than possibly seeing another side of things and working things out.

In real life, I don't hear any MD's talking about these topics. They are not concerned with a few DNP's on TV. Their practices are not threatened by NP's because they are good at what they do, and the patients want to come to them over another provider. They welcome midlevels into thier practices, and generally feel that NP's bring an important aspect to patient care.

Your agenda should be to convince patients that you provide superior care to midlevels so that they choose the MD route, not to come out and try to crush midlevels. That is only going to convince the public that MD's are greedy and are only concerned with losing money.

What makes you the authority on what NP's want? You don't work with them, you don't associate or speak with them. If you want to say that I am guilty by association, than I guess that means you are too. When MD's go on TV for killing patients or are busted for stealing from medicaid/medicare, you should go public and stand behind them, because they are MD's and all MD's are the same just like all NP's are the same.

 

[core0]

This is not true. Mary Mundinger's DNP program at Columbia routinely advertises their ability to admit patients to the hospital, where they are followed by NPs with no MD oversight or "collaboration."

Actually this was discussed over at allnurses. What they advertise is that they have admitting privileges. If you look at the website it does not discuss physician collaboration. I have admitting privileges. But they require that I admit the patient under a physicians name. This is a requirement for medicare billing. There is probably someone here that works at Columbia that could answer this. The other question is like most FP practices how do they have time to see patients and handle the demands of hospitalized patients. I would guess that they use a hospitalist service like most FPs.

David Carpenter, PA-C

 

[NYRN]

I'm not sure why you brought up the LIP issue but if you read the JC definition its very clear that neither PAs or NPs are considered LIPs.
"Licensed independent practitioner: Any practitioner permitted by law and by the organization to provide care and services, without direction or supervision, within the scope of the practitioner license and consistent with individually assigned clinical responsibilities. When standards reference the term "licensed independent practitioner," this language is not to be construed to limit the authority of a licensed independent practitioner to delegate tasks to other qualified health care personnel (for example, physician assistants and advance practice registered nurses) to the extent authorized by state law or a state's regulatory mechanism or federal guidelines, and organizational policy."

The clarification allows the physician to delegate to both PAs and NPs.

As far as NPs were never under the supervision of MDs, I would recommend you review the history of the NP. The first NPs actually practiced under delegated physician authority as there was no practice act for NPs. The concept of the "independent NP" is relatively new (late 80's early 90's). There are still more than 10 states that require physician supervision of NPs.

As far as scope, I would challenge you to show me where NPs are allowed more freedom within an area. The only limit to PA scope is the physicians scope and what the physician allows the PA to do. Contrast this with the limitation on NP practice concerning surgery, patient population by age and setting (depending on state enforcement).

David Carpenter, PA-C

You are correct that PA's can be delegated tasks that are within the scope of PA and thier delegating MD. It is also correct that if an NP is working in a hospital and the hospital's rules require it, the NP can be delegated tasks by MD's. Are you saying that if a cardiac surgeon tells you to perform surgery you are allowed to do that? NP's are considered LIP's. PA's are not. In a hospital role they function pretty much the same. There are some minor differences that I have noticed. PA's cannot order restraints. PA's have to put thier orders in under an MD's name where NP's do not. The clarification of the rule you posted, is changing the restrictions that PA's had previously in the hospital setting.

These are copied and pasted from the NYS office of profession website:

A physician assistant ("PA") is a licensed health care professional who provides medical care under the supervision of a physician. PAs provide a wide range of care within the area of practice of the supervising physician.

A nurse practitioner (NP) is an RN who has earned a specialty certificate as a license to practice through additional education and experience. Nurse practitioners may diagnose, treat, and prescribe exclusively and autonomously within a State designated specialty area of practice in collaboration with a licensed physician qualified to collaborate in the specialty in accordance with an approved written collaborative practice agreement and practice protocols.

Nurse Practitioners:
Diagnose illnesses and conditions exclusively within a licensed specialty area of care. Prescribe a plan of corrective care including diagnostic tests, medications, minor surgery, and diagnostic and corrective procedures. Make appropriate collegial referrals to other authorized providers. Nurse Practitioners do not initiate major surgery or deliver babies.

Where does it say that they are supervised by MD's?

The truth is David, some MD's will do whatever they can to go against us, even if its based on false beliefs or if its not in the best interest of patient care. Luckily for us, the MD's we work with see us as valuable members of the healthcare team and don't feel the way this group does.

 

[ToldYouSo]

Wow...after reading all 17 pages of this thread, it's clear to me that this issue is very messy. I do think that the encroachment of the DNP field is frightening and needs to be addressed. Although I'm only a college freshman in a combined dental program, I did send emails to the various organizations where appropriate. This is off topic, but reading this entire thread was what I thought a great lesson on debate...reading the various replies and how people interpreted what others said. There are a lot of very very bright people on this forum, and I found it refreshing to see so many residents who are passionate about this issue.

 

[Charles_Carmichael]

MD's are entitled to their own opinion. I wouldn't expect any group to sit there if another group was trying to push them out. My plan is to befriend you and then change your minds? I don't think so. Whether you like it or not, nurses and NP's are important to patient care. We should be working TOGETHER not against each other. I came here to engage in intellegent discussion regarding healthcare and to try to see if NP's and MD's could come to some sort of compromise. Apparently, people are more interested in being nasty and holding on to false beliefs than possibly seeing another side of things and working things out.

In real life, I don't hear any MD's talking about these topics. They are not concerned with a few DNP's on TV. Their practices are not threatened by NP's because they are good at what they do, and the patients want to come to them over another provider. They welcome midlevels into thier practices, and generally feel that NP's bring an important aspect to patient care.

Your agenda should be to convince patients that you provide superior care to midlevels so that they choose the MD route, not to come out and try to crush midlevels. That is only going to convince the public that MD's are greedy and are only concerned with losing money.

What makes you the authority on what NP's want? You don't work with them, you don't associate or speak with them. If you want to say that I am guilty by association, than I guess that means you are too. When MD's go on TV for killing patients or are busted for stealing from medicaid/medicare, you should go public and stand behind them, because they are MD's and all MD's are the same just like all NP's are the same.

I don't get the whole "we should work together" thing. At the same time you're telling physicians we need to work together, NPs/DNPs are lobbying for expansion of scope, being quoted saying they're equivalent to physicians except for the pay, or even saying they are superior (!) to physicians. How is that working together again?

You keep saying that most NPs/DNPs don't support the current movement. Well, I've never seen a single article written by one of these silent majority NPs nor have I seen anything to suggest that this "majority" is trying to prevent this current trend towards expansion of scope. All I see is NPs/DNPs posting on anonymous forums saying that the majority don't support the movement and that's it. So, where is this "majority" voicing its opinion? And how come I never hear their voice?

It's also not up to physicians to prove they provide better care than midlevels. The NPs/DNPs have the burden of proof to show equivalent outcomes, etc. Unfortunately, there is absolutely not a single well-done study that suggests this. There are, however, a bunch of badly designed studies that NPs/DNPs continue to cite. I guess all those stats courses in their curricula aren't helping them at all.

 

[J1515]

.

 

[NYRN]

I don't get the whole "we should work together" thing. At the same time you're telling physicians we need to work together, NPs/DNPs are lobbying for expansion of scope, being quoted saying they're equivalent to physicians except for the pay, or even saying they are superior (!) to physicians. How is that working together again?

You keep saying that most NPs/DNPs don't support the current movement. Well, I've never seen a single article written by one of these silent majority NPs nor have I seen anything to suggest that this "majority" is trying to prevent this current trend towards expansion of scope. All I see is NPs/DNPs posting on anonymous forums saying that the majority don't support the movement and that's it. So, where is this "majority" voicing its opinion? And how come I never hear their voice?

It's also not up to physicians to prove they provide better care than midlevels. The NPs/DNPs have the burden of proof to show equivalent outcomes, etc. Unfortunately, there is absolutely not a single well-done study that suggests this. There are, however, a bunch of badly designed studies that NPs/DNPs continue to cite. I guess all those stats courses in their curricula aren't helping them at all.

Like I've said many times before, its ignorant to include all NP's in the same group. When the vote comes up for us to support legislation asking for equal scope to MD's, we will vote no. We don't ever see it even getting to that point, so I am not holding my breath waiting for a ballot. Do you go on TV pushing for the BOM for harsher punishment for MD's who practice negligently? No, most MD's just take measures to improve/maintain the care they provide and make sure that they are not the ones being sued or getting their licenses revoked by the BOM. If your analogy is what you stand by, than by you not pushing for harsher punishment means that you endorse negligent care.

The public does not care about our studies. It makes no difference if the studies are done by MD's or NP's. There will be people who distrust either group and who think that the studies are biased. People make the decision on who they like better and who they will seek out for care. If people like NP's/PA's better than MD's, no studies done by MD's is going to change that. If people want MD's than no nursing study is going to change that either. There are many people out there that are convinced that MD's are greedy and care only about the money. If you are making it seem like you are trying to crush any "competition" then this will just reinforce these beliefs. The way to win these people over is to show them how MD's are better and have them CHOOSE MD providers.

 

[core0]

You are correct that PA's can be delegated tasks that are within the scope of PA and thier delegating MD. It is also correct that if an NP is working in a hospital and the hospital's rules require it, the NP can be delegated tasks by MD's. Are you saying that if a cardiac surgeon tells you to perform surgery you are allowed to do that? NP's are considered LIP's. PA's are not. In a hospital role they function pretty much the same. There are some minor differences that I have noticed. PA's cannot order restraints. PA's have to put thier orders in under an MD's name where NP's do not. The clarification of the rule you posted, is changing the restrictions that PA's had previously in the hospital setting.

These are copied and pasted from the NYS office of profession website:

A physician assistant ("PA") is a licensed health care professional who provides medical care under the supervision of a physician. PAs provide a wide range of care within the area of practice of the supervising physician.

A nurse practitioner (NP) is an RN who has earned a specialty certificate as a license to practice through additional education and experience. Nurse practitioners may diagnose, treat, and prescribe exclusively and autonomously within a State designated specialty area of practice in collaboration with a licensed physician qualified to collaborate in the specialty in accordance with an approved written collaborative practice agreement and practice protocols.

Nurse Practitioners:
Diagnose illnesses and conditions exclusively within a licensed specialty area of care. Prescribe a plan of corrective care including diagnostic tests, medications, minor surgery, and diagnostic and corrective procedures. Make appropriate collegial referrals to other authorized providers. Nurse Practitioners do not initiate major surgery or deliver babies.

Where does it say that they are supervised by MD's?

The truth is David, some MD's will do whatever they can to go against us, even if its based on false beliefs or if its not in the best interest of patient care. Luckily for us, the MD's we work with see us as valuable members of the healthcare team and don't feel the way this group does.

Its really obvious that you really don't understand how this works. You keep using the term LIP like it means something. The JC uses at least four different definitions and its strikingly obvious from the example you provided that in the instance you provided it does not include NPs.

Since you brought up NY its important to understand the practice instead of just quoting random bits of flotsam and jetsam from a website.

For NPs:
Must work under protocols. Must meet with "collaborating" physician and review patient records every three months. Must have a collaborating agreement with a physician where they are limited to what the NP and collaborating physician agree is the scope of practice.
Source:
http://www.op.nysed.gov/prof/nurse/part64.htm#sect64.4

For PAs:
No protocols. Medical acts assigned to the PA and within the scope of the physician. No requirements for chart review or meetings. No requirements for a written agreement between the PA and physician.
source:
http://www.op.nysed.gov/prof/med/article131-b.htm

So what exactly is the difference between collaboration and supervision? How is the NP able to have more freedom within their area? YMMV depending on where you are in the country. There are areas where the NP practice act has clear advantages over the PA practice act and vice versa.

98% of PAs and NPs work for healthcare organizations of some type (hosptials/physician practices etc). In those situations they work with the supervision and guidance of the physicians. Physicians are the gold standard in the medical field. To pretend anything else is sophistry. You can try to use terms like LIP and "independent but in the end PAs and NPs work for and with physicians.

David Carpenter, PA-C

 

[NYRN]

Its really obvious that you really don't understand how this works. You keep using the term LIP like it means something. The JC uses at least four different definitions and its strikingly obvious from the example you provided that in the instance you provided it does not include NPs.

Since you brought up NY its important to understand the practice instead of just quoting random bits of flotsam and jetsam from a website.

For NPs:
Must work under protocols. Must meet with "collaborating" physician and review patient records every three months. Must have a collaborating agreement with a physician where they are limited to what the NP and collaborating physician agree is the scope of practice.
Source:
http://www.op.nysed.gov/prof/nurse/part64.htm#sect64.4

For PAs:
No protocols. Medical acts assigned to the PA and within the scope of the physician. No requirements for chart review or meetings. No requirements for a written agreement between the PA and physician.
source:
http://www.op.nysed.gov/prof/med/article131-b.htm

So what exactly is the difference between collaboration and supervision? How is the NP able to have more freedom within their area? YMMV depending on where you are in the country. There are areas where the NP practice act has clear advantages over the PA practice act and vice versa.

98% of PAs and NPs work for healthcare organizations of some type (hosptials/physician practices etc). In those situations they work with the supervision and guidance of the physicians. Physicians are the gold standard in the medical field. To pretend anything else is sophistry. You can try to use terms like LIP and "independent but in the end PAs and NPs work for and with physicians.

David Carpenter, PA-C

I never said that MD is not the gold standard. I think everyone knows that. NP's and PA's in the end for the most part do work for MD's, and they WANT to work with and for MD's. I pasted below info from the NYS website. These are some things I found that were described in the PA role that were not in the NP role. A family member of mine is a PA, and she is very good at what she does. She has been in practice well over 20 years, and she is an excellent practitioner. She encouraged me to do NP over PA as well because of the limitations of practice here in NY. I'm sure the practice varies by state, but the state you are going to practice in is the state it should matter the most to the individual.
[URL="http://www.health.state.ny.us/professionals/doctors/conduct/physician_assistant.htmH"]http://www.health.state.ny.us/professionals/doctors/conduct/physician_assistant.htmH[/URL].

<H2>D. Supervision

A physician assistant works under the supervision of a licensed physician who is responsible for the physician assistant's performance
</H2>Malpractice Insurance

Individual liability coverage for the physician assistant is advisable but not required. PAs share responsibility and liability with their supervising physicians and either or both may be named in a malpractice action. While PAs are considered "dependent professionals," they are still responsible to perform competently

4. Private Practices Physician assistants may not be co-owners with physicians. Physician assistants may perform medical services, but may not practice medicine. Physician assistants and physician assistants' professional entities may not engage in independent practice, and may not employ physician supervisors or hire physician supervisors through an independent contract or other mechanism.

 

[acesup123]

This was taken from the DNP program website at Columbia

The Doctor of Nursing Practice program prepares nurses with the knowledge, skills and attributes necessary for fully accountable practice with patients across sites and over time. With the increasing scope of clinical scholarship in nursing and the growth of scientific knowledge in the discipline, doctoral level education is required for independent practice. The curriculum includes content which enables the graduate to conduct complex diagnostic and treatment modalities, utilize sophisticated informatics and decision-making technology, and assimilate in-depth knowledge of biophysical, psychosocial, behavioral and clinical sciences. The Residency and portfolio provide mastery and evidence of competency achievement.
Given the complexity of care, growth of information and biomedical technology, an aging and increasingly diverse population, and worsening disparities in care, the need for a DNP program to prepare clinicians to fill the growing societal need for expert clinicians is timely and necessary.
The DNP is the natural evolution and needed expansion of existing clinical degrees in nursing: the basic BS and the site-specific MS. The curriculum plan was developed with the intent of producing advanced practice nurses who can utilize skills and knowledge to independently provide expert nursing care in all care settings.


So according to this site the natural progession of nurses is to "evolve" into doctors or noctors.

 

[JaggerPlate]

This was taken from the DNP program website at Columbia

The Doctor of Nursing Practice program prepares nurses with the knowledge, skills and attributes necessary for fully accountable practice with patients across sites and over time. With the increasing scope of clinical scholarship in nursing and the growth of scientific knowledge in the discipline, doctoral level education is required for independent practice. The curriculum includes content which enables the graduate to conduct complex diagnostic and treatment modalities, utilize sophisticated informatics and decision-making technology, and assimilate in-depth knowledge of biophysical, psychosocial, behavioral and clinical sciences. The Residency and portfolio provide mastery and evidence of competency achievement.
Given the complexity of care, growth of information and biomedical technology, an aging and increasingly diverse population, and worsening disparities in care, the need for a DNP program to prepare clinicians to fill the growing societal need for expert clinicians is timely and necessary.
The DNP is the natural evolution and needed expansion of existing clinical degrees in nursing: the basic BS and the site-specific MS. The curriculum plan was developed with the intent of producing advanced practice nurses who can utilize skills and knowledge to independently provide expert nursing care in all care settings.


So according to this site the natural progession of nurses is to "evolve" into doctors or noctors.

Whenever I'm confident and feel something is sufficient, I excessively stress my point at least 3x.