nurses-masquerading-as-doctors

[wine is good]

I never said that there was a group that actually claimed all MD's are in the pockets of the drug companies. I was saying that IF there were a few MD's who went on TV saying "although you Joe Plumber don't know it, your doctor is doing it too even if you don't know about it", would you want these MD's representing YOU?

Maybe it was on the other thread where I posted that NP/PA/ND/Chiropractors should accept the fact that if they did not to medical school they cannot expect to practice the same as physicians. These DNP's that go on TV are as representative of our profession as those few MD's described above would be of you.

The difference is your example is a hypothetical one regarding the MD. My example is a real one, regarding the militant DNP. Anyway, it doesn't matter. See my above post. YOu guys want equivalence. That's it. Even if you claim you don't, you do just by practice you do. Unless you want an MD or DO to oversee you. Are you okay with that? NO, then, fine, you want equivalence.

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[NYRN]

Equivalent education to what? These two sentences are contradictory, unless I am misreading them.

I mean, the education of an NP/PA/CRNA is not equivalent to an MD no matter how you slice it. I'm saying that if a midlevel wanted an equal scope of practice to an MD, than they have to go to medical school.

 

[wine is good]

I mean, the education of an NP/PA/CRNA is not equivalent to an MD no matter how you slice it. I'm saying that if a midlevel wanted an equal scope of practice to an MD, than they have to go to medical school.

I tell you what. You win. You can have your practice. Hell, have them call you a doctor. Let the lawyers loose. It's time for equal responsibility. Now I know why you want tort reform. Because, you know some time soon, you'll be the target. It may get ugly, my friend. Really ugly.

 

[NYRN]

The difference is your example is a hypothetical one regarding the MD. My example is a real one, regarding the militant DNP. Anyway, it doesn't matter. See my above post. YOu guys want equivalence. That's it. Even if you claim you don't, you do just by practice you do. Unless you want an MD or DO to oversee you. Are you okay with that? NO, then, fine, you want equivalence.

You are saying that ALL NP's just by becoming NP's are agreeing with the agenda of a few. If you believe that all practitioners should be grouped together, than I guess you feel that this article reflects you: http://www.nytimes.com/2006/09/09/opinion/09sat4.html What would you say to your patient when he/she says that you must have harmed them in some way and covered it up if they do not have the outcome they expected? Do you think it would be fair that they feel this way just because of a few MD's who screw up and then cover it up?

NP's have never been supervised by MD's. Not for one day over the past 30 years or so. Collaboration is not the same as supervision. It has been working fine during all those years, and I don't see why it should change. If you continue to believe that ALL NP's are pushing for equal scope than you are dead wrong. Base your beliefs on facts, not opinions. Show me anything you can find that the MAJORITY of NP's want equal scope of practice to MD's.

 

[jbz24]

You are saying that ALL NP's just by becoming NP's are agreeing with the agenda of a few. If you believe that all practitioners should be grouped together, than I guess you feel that this article reflects you: http://www.nytimes.com/2006/09/09/opinion/09sat4.html What would you say to your patient when he/she says that you must have harmed them in some way and covered it up if they do not have the outcome they expected? Do you think it would be fair that they feel this way just because of a few MD's who screw up and then cover it up?

NP's have never been supervised by MD's. Not for one day over the past 30 years or so. Collaboration is not the same as supervision. It has been working fine during all those years, and I don't see why it should change. If you continue to believe that ALL NP's are pushing for equal scope than you are dead wrong. Base your beliefs on facts, not opinions. Show me anything you can find that the MAJORITY of NP's want equal scope of practice to MD's.

Joking right? NPs in many hospitals are supervised the same way PAs are.

 

[wine is good]

Joking right? NPs in many hospitals are supervised the same way PAs are.

I wasn't going to post anymore, but, i'm glad you mentioned this. She was going in so many directions I completely missed it.

 

[Dr Oops]

You are saying that ALL NP's just by becoming NP's are agreeing with the agenda of a few. If you believe that all practitioners should be grouped together, than I guess you feel that this article reflects you: http://www.nytimes.com/2006/09/09/opinion/09sat4.html What would you say to your patient when he/she says that you must have harmed them in some way and covered it up if they do not have the outcome they expected? Do you think it would be fair that they feel this way just because of a few MD's who screw up and then cover it up?

NP's have never been supervised by MD's. Not for one day over the past 30 years or so. Collaboration is not the same as supervision. It has been working fine during all those years, and I don't see why it should change. If you continue to believe that ALL NP's are pushing for equal scope than you are dead wrong. Base your beliefs on facts, not opinions. Show me anything you can find that the MAJORITY of NP's want equal scope of practice to MD's.

If thats your position then nursing practice should be strictly regulated to what they were trained to do-Nursing; and ANY practice of medicine should be strictly limited to people with MEDICAL licenses and those who work supervised by them.

The problem is that nurses try to blur the line between medicine and nursing to claim they are still practicing nursing when in reality as your more militant faction has claimed, you do the same thing for less money.

Majority of docs do not support the AMA but the public believes they do. Perception is everything. If you really think these people are crackpots get rid of them and stop having nurse after nurse going on tv.

By 2015 all NPs are going to be required to have a DNP. If most nurses were against independent practice and they know this degree awards them nothing why would they want they be outraged at the idea of having to spend more money to get a useless degree?

 

[jbz24]

I wasn't going to post anymore, but, i'm glad you mentioned this. She was going in so many directions I completely missed it.

I think NYRN needs to brush up on HER medical knowledge. At my hospital just north of hers, we have an NP services that are DIRECTLY supervised by attendings. The NPs do all the scut (write notes for patients, put in attendings' orders, etc.) but have no say in the management of the patient. They are basically glorified medical students without the knowledge base. We also have PAs who have similar roles, but from my experience, at least the PAs try to add to the discussion and I often see them trying to improve their medical knowledge (read up on patients, go to lectures, be present at attending rounds, etc.).

 

[NYRN]

Joking right? NPs in many hospitals are supervised the same way PAs are.

NP's are LIP's. By law they are not required to be supervised by doctors. Hospitals can set any rules they want in regards to restriction of NP/PA/MD's function. Most hospitals do not allow the NP's the scope they would have if they were outside of the hospital, but others have admitting privledges and have little restriction. There is a PA medicine service that runs the show on one floor. The chairman of medicine is technically in charge of them, but he rarely has to get involved. There are also restrictions on MD practice within hospitals. Only oncologists can order chemo. Only pain service (anesth) MD's can order PCA or epidural. EM MD's cannot use propofol for conscious sedation. In some hospitals nobody but anesthesia can intubate on the floors or in the ER, although this is becoming more rare as BC EM physicians are replacing internal med or surgery MD's working in ED's. These things are not all true in all hospitals, but they do exist.

 

[jbz24]

NP's are LIP's. By law they are not required to be supervised by doctors. Hospitals can set any rules they want in regards to restriction of NP/PA/MD's function. Most hospitals do not allow the NP's the scope they would have if they were outside of the hospital, but others have admitting privledges and have little restriction. There is a PA medicine service that runs the show on one floor. The chairman of medicine is technically in charge of them, but he rarely has to get involved. There are also restrictions on MD practice within hospitals. Only oncologists can order chemo. Only pain service (anesth) MD's can order PCA or epidural. EM MD's cannot use propofol for conscious sedation. In some hospitals nobody but anesthesia can intubate on the floors or in the ER, although this is becoming more rare as BC EM physicians are replacing internal med or surgery MD's working in ED's. These things are not all true in all hospitals, but they do exist.

Changing the definition now. Not required? You said NPs are NEVER supervised by MDs. What about the (many) hospitals that DO require this?

 

[wine is good]

NP's have never been supervised by MD's. Not for one day over the past 30 years or so. .

So are you retracting your BS statement? Make note to yourself: Don't make over-exaggerated statements in a public forum in order to win people over

Man, I just can leave today, it's just so addicting.

 

[NYRN]

I think NYRN needs to brush up on HER medical knowledge. At my hospital just north of hers, we have an NP services that are DIRECTLY supervised by attendings. The NPs do all the scut (write notes for patients, put in attendings' orders, etc.) but have no say in the management of the patient. They are basically glorified medical students without the knowledge base. We also have PAs who have similar roles, but from my experience, at least the PAs try to add to the discussion and I often see them trying to improve their medical knowledge (read up on patients, go to lectures, be present at attending rounds, etc.).

NP's never try to brush up on knowledge or learn new things

Those who keep saying that I am pushing for the DNP and expanded scope are making things up. I have no more control over these DNP's who go on TV than these doctors that you see on the news going to jail for sexual assault on thier patients, or whistleblowers who are going against their own.

You are being hypocritical if you are saying its OK for these NP's to represent all NP's but the AMA does not represent most of the doctors practicing in this country if they take a position you don't agree with.

 

[jbz24]

NP's never try to brush up on knowledge or learn new things

I said "from my experience."

 

[NYRN]

Changing the definition now. Not required? You said NPs are NEVER supervised by MDs. What about the (many) hospitals that DO require this?

I think you are misunderstanding me. BY LAW, NP's are LIP's who work in collaboration with MD's. Collaboration is not the same thing as supervision. In private practice, an NP does not need to be supervised by an MD. That is how it has been for 30 years.

Hospitals can make their own rules as to how clinicians function. If they do not want NP's or PA's functioning without MD supervision, they have the right to make that rule. If an NP/PA doesn't like it, they shouldn't work there. In my hospital CRNA's are not allowed to put orders in. In other places they do. Same goes for MD's. In my ER the attending MD's are allowed to use propofol for consious sedation. In others, they are not.

 

[jbz24]

I think you are misunderstanding me. BY LAW, NP's are LIP's who work in collaboration with MD's. Collaboration is not the same thing as supervision. In private practice, an NP does not need to be supervised by an MD. That is how it has been for 30 years.

Hospitals can make their own rules as to how clinicians function. If they do not want NP's or PA's functioning without MD supervision, they have the right to make that rule. If an NP/PA doesn't like it, they shouldn't work there. In my hospital CRNA's are not allowed to put orders in. In other places they do. Same goes for MD's. In my ER the attending MD's are allowed to use propofol for consious sedation. In others, they are not.

You first said and I quote, "NP's have never been supervised by MD's." meaning that there was never an NP who was supervised by an MD. Next you said "By law they are not required to be supervised by doctors." hinting that MDs can supervise NPs but it isn't mandated. Now it's "NP's are LIP's who work in collaboration with MD's." Make up your mind already. Regardless of what the law says, most hospitals will not allow NPs to run rampant independently inpatient, and for good reason.

 

[NYRN]

You first said and I quote, "NP's have never been supervised by MD's." meaning that there was never an NP who was supervised by an MD. Next you said "By law they are not required to be supervised by doctors." hinting that MDs can supervise NPs but it isn't mandated. Now it's "NP's are LIP's who work in collaboration with MD's." Make up your mind already. Regardless of what the law says, most hospitals will not allow NPs to run rampant independently inpatient, and for good reason.

I think you are just misunderstanding what I am saying. What I meant by NP's have never been supervised by MD's is that the law does not mandate MD supervison for them to practice. I did not mean to imply that NP's NEVER EVER function without MD supervision especially in a hospital setting. Working in collaboration means working alongside MD's with both parties contributing to the care of the patient. I do not see how that could be a bad thing for a patient. This already exists with many team members including social workers, dieticians, physical therapists. MD's don't take care of every single thing the patient gets in the hospital or in private practice. There should be collaboration between all team members.

Like I said before, hospitals can set thier own rules. If they require MD supervision, the NP must follow the rules there if he/she wants to work there. If they allow an NP/PA service, that is their perogative to do so.

This is cut and pasted from an article out of the American Academy of Pediatrics:

NP is a registered nurse with advanced education and clinical training beyond the usual 2 to 4 years of basic nursing education required for state licensure. Most NPs acquire a master's degree in nursing as their route to certification. In some states, the NP is required by law to work in collaboration with a physician. The NP can provide only those services specifically articulated by state statute and in accordance with a written practice agreement with a licensed physician. In other states, NPs have been granted independent practice and prescribing authority.4

PA A PA is registered by the state after 2 or more years of undergraduate education followed by 9 to 12 months of preclinical didactic studies and 9 to 15 months of physician-supervised clinical education. By law, PAs may perform medical services, but only when supervised by a physician and only when such acts and duties are within the scope of practice of the supervising physician.

 

[Socrates25]

NYRN, you are wrong. You clearly stated that no NP had ever been supervised by an MD, which is obviously 100% false. Also, you are wrong about state laws requiring only "collaboration." Some states do require SUPERVISION, not just collaboration.

Here is the relevant Oklahoma state law:

OAC 435:10-13-2. Eligibility to supervise advanced practice nurse with prescriptive authority
(a) To be eligible to serve as supervising physician for the advanced practice nurse with prescriptive authority, an allopathic physician shall meet the following criteria:
(1) Have possession of a full and unrestricted Oklahoma medical license with Drug Enforcement Agency (DEA) and Oklahoma Bureau of Narcotics (OBN) permits for any drug on the formulary as defined in the Oklahoma Nursing Practice Act.
(2) The physician shall be in an active clinical practice in which no less than twenty (20) hours per week shall involve direct patient contact.
(3) The supervising physician shall be trained and fully qualified in the field of the advanced practice nurse's specialty.
(4) No physician shall supervise more than two (2) full time equivalent advanced practice nurses regarding their prescriptive authority at any one time. For purposes of this section, each "full time equivalent" advanced practice nurse position equals forty (40) hours per week collectively worked by the part-time advanced practice nurses being supervised by the physician. Notwithstanding the provisions for the supervision of two (2) full time equivalent advanced practice nurses above, no physician shall supervise more than a total of four (4) advanced practice nurses. The Board may make an exception to any limit set herein upon request by the physician.
(b) Proper physician supervision of the advanced practice nurse with prescriptive authority is essential. The supervising physician should regularly and routinely review the prescriptive practices and patterns of the advanced practice nurse with prescriptive authority. Supervision implies that there is appropriate referral, consultation, and collaboration between the advanced practice nurse and the supervising physician.

"Supervision implies that there is appropriate referral, consultation, and collaboration between the advanced practice nurse and the supervising physician."

 

[NYRN]

NYRN, you are wrong. You clearly stated that no NP had ever been supervised by an MD, which is obviously 100% false. Also, you are wrong about state laws requiring only "collaboration." Some states do require SUPERVISION, not just collaboration.

Here is the relevant Oklahoma state law:

States that require collaboration do not always require supervison. Only 5 states require supervision. There is a chart here that explains what NP's are allowed to do by state. http://www.acnpweb.org/files/public/UCSF_Chart_2007.pdf

http://www.acnpweb.org/files/public/UCSF_Chart_2007.pdf

In the above document, it states that AMA does not have an official definition of collaboration. The ANA endorsed the statement that collaboration means working together as collegues, within their scopes of practice. It also says that although supervision and delegation may be the legal requirement in some states, the training and competencies inherent in your degree of education will hold you to a higher standard than a subordinate employee.

 

[wine is good]

States that require collaboration do not always require supervison. Only 5 states require supervision. There is a chart here that explains what NP's are allowed to do by state. http://www.acnpweb.org/files/public/UCSF_Chart_2007.pdf

http://www.acnpweb.org/files/public/UCSF_Chart_2007.pdf

In the above document, it states that AMA does not have an official definition of collaboration. The ANA endorsed the statement that collaboration means working together as collegues, within their scopes of practice. It also says that although supervision and delegation may be the legal requirement in some states, the training and competencies inherent in your degree of education will hold you to a higher standard than a subordinate employee.

YOU WERE WRONG. You posted bunch of B s h i t about things that were not correct and are not brave enough to admit it. You keep retracting and adding addendum's and clarifications. ENOUGH.

 

[NYRN]

YOU WERE WRONG. You posted bunch of B s h i t about things that were not correct and are not brave enough to admit it. You keep retracting and adding addendum's and clarifications. ENOUGH.

Was I wrong about the 5 out of 50 states? Sure I'll admit it. Why don't YOU admit about the many things you were wrong about? I am not retracting anything. I was posting a chart and an official document that explains roles and scopes of practice so that there is no debate, its all there in black and white.

 

[jbz24]

Honestly though, many of us don't care what the intentions of NPs or DNPs are for that matter. We want to prophylactically nip this in the bud. With the increasing debt burden on medical students and decreasing wages, we don't want to lose what we have left. With the increasing number of medical student spots and the increasing number of people who have been going into primary care residencies (especially this year, as quoted by the NRMP), we don't feel we need to relinquish any power to nurses. Once residency spots are expanded to accommodate the increase in medical students, hopefully this whole issue becomes moot.

 

[wine is good]

Was I wrong about the 5 out of 50 states? Sure I'll admit it. Why don't YOU admit about the many things you were wrong about? I am not retracting anything. I was posting a chart and an official document that explains roles and scopes of practice so that there is no debate, its all there in black and white.

What was I wrong about? I just stated my opinions about the issues.

I don't think against medical advice discharges are much of an legal issues. YOu stated anecdotal evidence. That doesn't make me wrong. You stated tort reform and PAs should be bigger issues than DNPs. I don't think that's correct. Those are my opinions.

You tried to state a matter of fact claims which others, very cleverly, shot down with proof.

 

[NYRN]

Honestly though, many of us don't care what the intentions of NPs or DNPs are for that matter. We want to prophylactically nip this in the bud. With the increasing debt burden on medical students and decreasing wages, we don't want to lose what we have left. With the increasing number of medical student spots and the increasing number of people who have been going into primary care residencies (especially this year, as quoted by the NRMP), we don't feel we need to relinquish any power to nurses. Once residency spots are expanded to accommodate the increase in medical students, hopefully this whole issue becomes moot.

Finally, something that is worth discussing and pushing for. People respect physicians and all the hard work and sacrifices they make to obtain the title and position they hold. I agree 100% that no practitioner, including MD's/PA's or whatever else pops up in the future, should ever replace MD's. The issue of loan forgiveness and increasing MD residencies and retention in family practice can only serve to help people get the healthcare they need. Anybody that is truly concerned for patient care should agree with this.

 

[Instatewaiter]

Pt has to stay in house. I will physicially handcuff the pt to the bed and prevent him from leaving. Then, go to court and be sued and explain why didn't allow a perfectly sane human adult from leaving the hospital, thus be charged with wrontgful imprisonment, kidnapping, unlawful arrest, sodomy, sexual assault, etc etc.

Ok I get the handcuffing to keep the patient in house but what the hell else were you doing?

You are saying that ALL NP's just by becoming NP's are agreeing with the agenda of a few. If you believe that all practitioners should be grouped together, than I guess you feel that this article reflects you: http://www.nytimes.com/2006/09/09/opinion/09sat4.html

The difference is, physicians would denounce such action because it is wrong. Physicians speak out against this kind of misconduct. No doc would be on board with this.

Nurses not speaking up against the rogue DNPs means they want the benefits. They are on board with it- no matter the danger

I think NYRN needs to brush up on HER medical knowledge. At my hospital just north of hers, we have an NP services that are DIRECTLY supervised by attendings. The NPs do all the scut (write notes for patients, put in attendings' orders, etc.) but have no say in the management of the patient.

The same thing happens at my hospital. They really are closer to glorified residents though.

NP's are LIP's. By law they are not required to be supervised by doctors. Hospitals can set any rules they want in regards to restriction of NP/PA/MD's function. Most hospitals do not allow the NP's the scope they would have if they were outside of the hospital, but others have admitting privledges and have little restriction.

I wonder why almost no hospital will give NPs the same kind of independence they can get outside of the hospital. I think that should tell the politicians something.

 

[NYRN]

Ok I get the handcuffing to keep the patient in house but what the hell else were you doing?



The difference is, physicians would denounce such action because it is wrong. Physicians speak out against this kind of misconduct. No doc would be on board with this.

Nurses not speaking up against the rogue DNPs means they want the benefits. They are on board with it- no matter the danger




The same thing happens at my hospital. They really are closer to glorified residents though.



I wonder why almost no hospital will give NPs the same kind of independence they can get outside of the hospital. I think that should tell the politicians something.

Doctors don't cover up each other's errors and are quick to disclose mistakes they make?? Yeah OK.

What would you like me to do? Go on TV? If a vote comes up, I will vote no. Doctors are also restricted as to what they can do inside the hospital. In some states it is illegal for doctors to perform surgery/procedures outside of the hospital that they would not be given privledges for in hospital because of bad outcomes/patient death. Isn't that practicing outside of your trained area and considered out of your scope of practice? I think the politicians should be aware of that as well.

 

[BassCaster]

jesus christ! how the hell do you guys have the patience to keep explaining and reexplaining the same **** page after page to nyrn? i stopped reading his/her posts a long time ago cause it's always just cherry picked answers, horrible metaphors, and contradictions. ignore his/her as* already and enjoy the rest of mother's day.

 

[NYRN]

jesus christ! how the hell do you guys have the patience to keep explaining and reexplaining the same **** page after page to nyrn? i stopped reading his/her posts a long time ago cause it's always just cherry picked answers, horrible metaphors, and contradictions. ignore his/her as* already and enjoy the rest of mother's day.

Yeah OK. Since you can't defend yourself against the truth, you throw a tantrum. Keep kidding yourself that the real world in medicine is what it is here on SDN. When you are a senior resident or attending, you will see how real life is in medicine.

Put your money where your mouth is. When you are interviewing for med school, residency and for attending jobs make sure you voice your dislike for nurses to your chairman/woman, program directors and adcoms. If you really believe that all doctors think like you do, you shouldn't hide your feelings. Remember, medicine is a small world. That nurses you curse out today could know the chairman of the department you are applying for a job or the program director of your desired residency. Believe it or not, if there are people with negative opinions of your behavior, it won't exactly help you get in the door.

I'm done. To those who engaged in intelligent discussion like the professionals you are supposed to be, good luck to all of you. To those who are acting like children, good luck getting through residency with that attitude.

 

[BassCaster]

Yeah OK. Since you can't defend yourself against the truth, you throw a tantrum. Keep kidding yourself that the real world in medicine is what it is here on SDN. When you are a senior resident or attending, you will see how real life is in medicine.

Put your money where your mouth is. When you are interviewing for med school, residency and for attending jobs make sure you voice your dislike for nurses to your chairman/woman, program directors and adcoms. If you really believe that all doctors think like you do, you shouldn't hide your feelings. Remember, medicine is a small world. That nurses you curse out today could know the chairman of the department you are applying for a job or the program director of your desired residency. Believe it or not, if there are people with negative opinions of your behavior, it won't exactly help you get in the door.

I'm done. To those who engaged in intelligent discussion like the professionals you are supposed to be, good luck to all of you. To those who are acting like children, good luck getting through residency with that attitude.

Peace out!

 

[Flopotomist]

One important aspect of all of this that is being missed is that nurses play a tremendously important role in the care of patients, and are vital. If nurses roles drift into the role of hte physician, then there is nobody to perform the important nursing role.

 

[acesup123]

One important aspect of all of this that is being missed is that nurses play a tremendously important role in the care of patients, and are vital. If nurses roles drift into the role of hte physician, then there is nobody to perform the important nursing role.

CNA's will perform the role of a nurse, nurses will perform the role of a physicicans and physicians will perform research. All the ivy schools are all about having their med students doing research, is this where physicians are headed?

 

[Siggy]

You know... one thing I've always wondered is how supervision and "collaboration" differ. It's like this entire, "We're not supervised, we're just required to collaborate with physicians. After all, what happens when the physician disagrees with the NP and eventually cuts the "collaboration" umbilical cord? Collaboration is just the NP new speak for supervision. Same end result (physician oversight), but with a friendlier, more huggable word.

 

[pianoman511]

You know... one thing I've always wondered is how supervision and "collaboration" differ. It's like this entire, "We're not supervised, we're just required to collaborate with physicians. After all, what happens when the physician disagrees with the NP and eventually cuts the "collaboration" umbilical cord? Collaboration is just the NP new speak for supervision. Same end result (physician oversight), but with a friendlier, more huggable word.

Yeah, what it really means is "if I screw up, then you can sue my supervising physician" and if a complicated case comes in that I manage appropriately with some advice from a collaborating physician that has a good outcome then "I can take credit for it".

 

[VA Hopeful Dr]

NP's are LIP's. By law they are not required to be supervised by doctors. Hospitals can set any rules they want in regards to restriction of NP/PA/MD's function. Most hospitals do not allow the NP's the scope they would have if they were outside of the hospital, but others have admitting privledges and have little restriction. There is a PA medicine service that runs the show on one floor. The chairman of medicine is technically in charge of them, but he rarely has to get involved. There are also restrictions on MD practice within hospitals. Only oncologists can order chemo. Only pain service (anesth) MD's can order PCA or epidural. EM MD's cannot use propofol for conscious sedation. In some hospitals nobody but anesthesia can intubate on the floors or in the ER, although this is becoming more rare as BC EM physicians are replacing internal med or surgery MD's working in ED's. These things are not all true in all hospitals, but they do exist.

Incorrect. In the link you posted, there are quite a few states where "supervision" is required.

 

[Instatewaiter]

What would you like me to do? Go on TV?

A good start is denounce the NP movement as dangerous and irresponsible on this board.

Doctors are also restricted as to what they can do inside the hospital. In some states it is illegal for doctors to perform surgery/procedures outside of the hospital that they would not be given privledges for in hospital because of bad outcomes/patient death. Isn't that practicing outside of your trained area and considered out of your scope of practice? I think the politicians should be aware of that as well.

An internist doing surgery is well outside of their scope of practice. Sure. Similarly, NPs practicing medicine independently (what they call advanced nursing) is outside of their scope of practice. The difference however is that internists aren't clamoring for surgical practice rights despite the inadequate training to do surgery. They don't want to do surgery, and if they do they go back to surgical residency.

NPs are clamoring for more rights despite wholly inadequate training to be independent. So your comparison is a poor one.

 

[PICUPNP]

[NP's have never been supervised by MD's. Not for one day over the past 30 years or so. Collaboration is not the same as supervision.

You have NO idea about what you're saying! I am an NP and have been supervised by physicians since I started working. The thing is is that NPs SHOULD have physician oversight and should not practice independently. Please stop making the rest of us NPs who are happy to practice under a physcian look like the rest of the dnp ego maniacs.

 

[NYRN]

[NP's have never been supervised by MD's. Not for one day over the past 30 years or so. Collaboration is not the same as supervision.

You have NO idea about what you're saying! I am an NP and have been supervised by physicians since I started working. The thing is is that NPs SHOULD have physician oversight and should not practice independently. Please stop making the rest of us NPs who are happy to practice under a physcian look like the rest of the dnp ego maniacs.

What state are you in? That makes a difference of how you may practice. You are also working in a hospital where NP's do work under supervision. Nobody is debating that. Where did I ever say that I wanted full scope or that I didn't want to work with MD's? My goal is to work with a specific MD group as well as in the hospital. Where in that job description am I saying I want full scope or to be equals to them? Again, look up the meaning of collabortion in the dictionary. It does not mean supervision.

 

[JaggerPlate]

What state are you in? That makes a difference of how you may practice. You are also working in a hospital where NP's do work under supervision. Nobody is debating that. Where did I ever say that I wanted full scope or that I didn't want to work with MD's? My goal is to work with a specific MD group as well as in the hospital. Where in that job description am I saying I want full scope or to be equals to them? Again, look up the meaning of collabortion in the dictionary. It does not mean supervision.

Ehhh, in your above statement you say you want to "work with a specific MD group." To me, and keep in mind that this is just my opinion, saying work "with" opposed to work "for" implies some sense of equality in both caliber and scope. I could work for Google and collaborate with my superiors on projects, but I don't work "with" Google as some sort of partner, internet mogul company. You know??

 

[jl lin]

Ok, I put my comment:

"My Navy chaplain friend just told me that two of his family practice physician buddies diagnosed him with pneumonia and gave him a paper sack of meds. My chaplain friend just didn't believe he had pneumonia so he went to a third FP. This guy didn't listen to my friend's chest through his shirt like the other two "cream of the crop" physicians did, but actually lifted his shirt, where he noticed an amazingly hairy chest. So sad indeed that such a basic mistake was made."

Whenever possible, which is 99% of the time, I listen directly on the skin, whether it be for lung sounds, heart sounds, vascular flow, whatever. Always have. I've paid close attention to striving for attention to detail in these assessment skills, and I have fortunately picked up sounds that have been diagnostically affirmed, such as on cardiac ultrasound.

Using these assessment skills are already viewed as somewhat subjective; therefore, why add to confusing it further. Take your time when possible, and listen directly, not over clothes. I don't stand there and tell other colleagues or other practictioners what to do. I just stand by my principles and try to be careful and limit adding even more subjectivity and potential confusion by doing the assessments right, and in my mind, that means not listening over clothes.

 

[jl lin]

I really think people are taking this fear too far. No one that understands anything about malpractice would want to take away a sound hierarchy. I mean even if you are an experienced physician, you should want to go to the physician with more experience and insight for direction and recommendation, etc when issues or concerns you are not strong on or are confused on come up. If you are all about the patient, titles and pride and all the rest should be set aside. Very often it takes more than a few heads to get some workable insight on what is going on with a patient. Humility and openness works wonders for people.

The concept of NPs or PAs taking over for physicians is totally a tempest in a teapot.

Physicians really do have bigger concerns on which to focus. I have a theory as to why some perpetuate this nurse/pa "midlevel" paranoia. Interestingly enough I find that secure physicians that are wonderful at what they do are no where near as worked up about it; b/c they know it's essentially a non-issue.

But some people love drama and controversy--somehow it makes them feel bigger, b/c somehow they feel so small.
They love making things "us versus them."

That's a bad way to go about approaching things in the clnical realm or on a message board. Sometimes we just have to face the reality that some just have this weak need to make a huge issue and stir up drama.

To me people should be rallying together about where healthcare is going, b/c no matter which way you slice it, it's in a MAJOR mess--and gov't control will make it worse. On top of that, no one is doing any serious work on addressing tort reform.

So people are worried about some impractical, unsustainable take over by "midlevels." Are you kidding me?
The bigger healthcare issues in politics now and tort reform are like the Titanic; yet folks are worried about a few bouys on the waterway. It's insane.

 

[NYRN]

Ehhh, in your above statement you say you want to "work with a specific MD group." To me, and keep in mind that this is just my opinion, saying work "with" opposed to work "for" implies some sense of equality in both caliber and scope. I could work for Google and collaborate with my superiors on projects, but I don't work "with" Google as some sort of partner, internet mogul company. You know??

The MD's in this group are some of the most brilliant minds I have ever come across. Even if I went to med school and did residency+fellowship I would never consider myself equal to them. I would be honored to work "for" them, even if they controlled every move I made.

 

[mfrizzo3]

http://www.doctorkara.com/

 

[daveyjwin]

http://www.doctorkara.com/

Don't you understand, no NPs want to call themselves doctors, they aren't seeking to supplant PCPs. This will all go away if we just ignore it. Now shush...

 

[JaggerPlate]

http://www.doctorkara.com/

PFFFFFFFFFFF holy crap. aisdjflksjdf wow that is awful. DR kara. At least she puts her credentials on the main page ... I guess she could have simply kept LYING.

 

[randomusername]

PFFFFFFFFFFF holy crap. aisdjflksjdf wow that is awful. DR kara. At least she puts her credentials on the main page ... I guess she could have simply kept LYING.

What I really love is how areas in which she did NP-school clinicals are listed in her biography. I guess family practice docs should start listing all of their clinical rotations and hours/rotation...

 

[AbbyNormal]

http://www.doctorkara.com/

Oh. My. God.

I am too sleep deprived to discuss all the ways this person offends me at the moment. This is not how a nurse practitioner should present her services, no how, no way.

But this part left me speechless:

"I love jokes! Bring me a joke when you visit. Laughter is the BEST medicine"




Totally unprofessional. I am embarrassed for the profession of nursing.

 

[wine is good]

Don't you understand, no NPs want to call themselves doctors, they aren't seeking to supplant PCPs. This will all go away if we just ignore it. Now shush...

I guess there you have it. Real proof what is out there. Can anyone now say that we are being "paranoid," and want "controversy."

Our family practice colleagues really have to step it up now.

Blatant misrepresentation by putting "Doctor" at the very top of her webpage. She is really good at self promotion and that part is actually is impressive, perhaps something to think about for real physicians.

She complains that couple of insurance carriers will not accept her into their plan because she is not associated with a real physician. She thinks that is discriminatory and wants the patients to call her representatives for her. How about that?

 

[bassstimme1]

Don't you understand, no NPs want to call themselves doctors, they aren't seeking to supplant PCPs. This will all go away if we just ignore it. Now shush...

And of course they would never, ever, try to get a politician to do their bidding and give them more practice rights through legislation...
From her site:
Update: IHC will not allow me to sign contracts with them because I do not have a physician associated with my clinic. UHC will only allow physicians to bill for services in an urban area; however, if my office was more than 30 miles from a hospital (their definition of rural), I would be allow to bill for services. Both companies have turned me down as a provider simply because I am not a physician. Interestingly I passed their credentialing reviews without problems, so my track record as an NP is not in question. I simply cannot sign contracts with them because of their INTERNAL policies.

Call Representative Jason Chaffetz of District #3 if you are concerned about lack of choice. He is willing to handle this restraint of trade issue through legislative means if the public is concerned about limited choices. I spoke with his office about restraint of trade already and they are interested in helping resolve this matter.

 

[jl lin]

I guess there you have it. Real proof what is out there. Can anyone now say that we are being "paranoid," and want "controversy."

Our family practice colleagues really have to step it up now.

Blatant misrepresentation by putting "Doctor" at the very top of her webpage. She is really good at self promotion and that part is actually is impressive, perhaps something to think about for real physicians.

She complains that couple of insurance carriers will not accept her into their plan because she is not associated with a real physician. She thinks that is discriminatory and wants the patients to call her representatives for her. How about that?

Tempest in a teapot. . .

After her name she writes Nurse Practitioner.


Don't underestimate all of the general public. As a RN, I've encouraged people that have asked me about certain conditions to make sure they see a physician. I recently advised one on this after the NP danced around a problem that has gone on for> 2 weeks, where she, wouldn't even as much as get a urine culture C & S or order an ultrasound for one pt. Now don't get me wrong. I've seen GP's do this as well. And I understand that there are insurance issues to consider, but I felt this NP was blowing things off, and the pt needed to not play around with her anymore--or perhaps needed a referral to a specialist. Any number of serious things could be going on with this woman. She was getting the run around and her pain and other symptoms were increasing not decreasing.

But people are getting more educated about not being blown off, whether it be by NPs or primary care physicians. If the individual patients don't become their own advocates, they may find themselves in trouble.

Personally, I think NP from the link should have clarified what her doctorate is in from the beginning of announcing herself.

Nonetheless, this "NP fear" is overstated, and most of the general public isn't going to buy taking serious health concerns and having them primarily managed by NPs. And hopefully they won't buy being brushed aside or ignored by any practitioner.

Sometimes pts have to leave some practices, b/c they are not getting a reasonable amount of attention to things. This happens more than some want to admit. And I know darn well patients can be extremely demanding at times or even non-compliant, but then they come back and still whine to the physicians. I totally get that. But we have to take patients as they are. Only if they aren't willing to do their own part, then, sometimes the physicians have to let them go. I will say that if physicians are too pizzy and not as understanding with pt/clts as they could be, there could be, sometime in the future, more of a move to NPs that are willing to listen and follow-through with them. People want to know that you genuinely give a damn about their care. If people miss this truth, they are missing an awful lot.


Bottom line though is this is not representative of most NPs, etc. What's more, as this NP advertises herself this way, she may be putting her license and livelihood and even "secure" funds in greater risk.

Let some major lawsuits come up for some of these yahoos. It won't be an issue. As I said, the biggest boon to them will come in academic settings, period.

Stop worrying about something that isn't a real issue, and focus on those issues in healthcare that truly are. Don't fixate on the few bouys here and there, when the ship is about ready to be torn by a Titanic sized iceberg.

 

[startswithb]

http://www.doctorkara.com/

Wow, is that website unprofessional. I guess if patients want to pay ca$h up front to hang out with this lady and have a cup of tea, go for it. There is nothing here about medical care.

 

[daveyjwin]

Stop worrying about something that isn't a real issue, and focus on those issues in healthcare that truly are. Don't fixate on the few bouys here and there, when the ship is about ready to be torn by a Titanic sized iceberg.

Yes, Yes, just ignore it... That's the best thing to do when problems are brewing. Best wait until they get full practice rights and become integrated in the system to worry about this.

Ever heard of nipping of problem in the bud?