Dr. Keith Ablow, a psychiatrist on Fox news, has posted on his blog the worst diatribe I have read in a long time. Read it here: http://health.blogs.foxnews.com/2010/04/15/nurses-masquerading-as-doctors/
Okay, here is my response. I will do my best to keep it civil. Paragraph by paragraph.
First of all, we will see what is in the future regarding the health care reform, but there is, and has been, a shortage of primary care physicians, especially in poor or rural areas. Patients all over America and many other countries have long received primary care from Nurse Practitioners (NPs) who worked independently, or in collaboration with a physician, depending on the state in which the NP has her license and where they choose to work. This is nothing new. Many studies on the effectiveness, safety and patient satisfaction with NP care point to equal or better outcomes than physician care (I have the references if anyone wants them) in the specialities that the NPs practice in: pediatrics, family practice, adult, and geriatric, to name a few. NPs can and do provide excellent primary and specialized care.
The education includes pharmacotherapeutics, and have completed the requisite hours in order to be able to prescribe safely, and have the same CEU requirements as physicians. Each state has their own laws regarding NP prescriptive privileges, but NPs write prescriptions in all states. Only 2 states do not allow NPs to prescribe controlled drugs such as cough medication, certain anti-diarrheals and pain medication. I, unfortunately live in one of them, Florida. Sixteen times a bill has been introduced and sixteen times shot down through the machinations of Florida Medical Association lobbyists, in spite of documented proof that NPs prescribe safely.
As to the right to be called “Doctor”. Doctor is an honorific for someone who has reached a doctorate level of education in any field, Dr. Ablow confuses this with the role of physician. But to answer his objection, NPs don’t generally want to be called doctor, even if they have the Doctor of Nursing Practice degree (DNP). When I get it, I will still introduce myself by my name and title of Nurse Practitioner. In 2015, DNP will be the entry-level degree for nurse practitioner certification, and physicians will have to stop being so touchy about it, we are all there for the patients. It isn’t about ego trips, or shouldn’t be. The minimum degree now is Master in Science of Nursing (MSN).
Obama care is an unknown entity so far, so calling it two-tiered care is just silly. I see no requirements that “poor” people can only see NPs and “rich” people get a “real” doctor. NPs are a resource for good primary care in a time of shortage of primary care MDs, and a great adjunct in the health care team as a whole. Many patients prefer the NP so money is not the issue. NPs are not trying to replace MDs.
Yes, medical school is rigorous and academically challenging, but so is nursing school. Getting into nursing school is tough, many schools have waiting lists of over two years. The average NP has had many years of education to get to where they are. I myself started as an EMT, then got a Nursing Diploma (3 years with many, many clinical hours), then got a BSN, (3 years with more clinical), now I am enrolled in a MSN-FNP program (3 more years and 700 hours of clinical time). All in all, I will have spent 10 years in school, and have 20 years of hands-on experience in nursing. I have worked in hospitals, home health, hospice and case management. I was top of my class every time I went to school, and have a 4.0 right now (and it was not easy!) I suspect most nurses who go the extra time and effort to be NPs are intelligent, hard-working, and driven to help patients. As to physicians having more “raw intellect” than the average nurse – aren’t we a tad arrogant, Dr. Ablow? I’ll match my IQ to yours any day and blow you out of the water.
What you are saying isn’t unpopular, it is untruthful in its insinuations. Suggesting nurse anesthetists (and advanced practice nurses in genreral) are second-rate is out-and-out ridiculous. Many rural hospitals don’t have anesthesiologists available, and would not be able to provide surgical and anesthesia services without CRNAs. Besides, anyone who works in the ER wears a mask and gown “just like the surgeon”, they aren’t hiding or masquerading, just doing their job, you moron. (Oops, sorry, not civil. Will be good…) You pay for anesthesia that is safe, and you get it. It is not relevant whether the one doing it is a nurse anesthetist or an anesthesiologist, they are both credentialed, licensed, and able to do the job equally well.
Also, please differentiate between nurses. I wouldn’t want a psychiatrist to decide if I had pneumonia or the flu, but I sure as hell would place myself in the capable hands of an NP. LPNs and RNs can’t do what you describe, but NPs can and do, and do it well.
- “How come no one in Congress would be able to tell you a story about that incredible nurse who diagnosed the rare condition in his or her child?” Because the idiots in Congress only listen to the lobbyists who give them lots of money, i.e. the AMA (which only represents 25% of physicians, by the way).
- ” How come nurses either failed to be admitted to medical school or didn’t try? ” Because they wanted to be nurses. Nurses are closer to patients (in general, there are always exceptions to the rule, my own MD is a good example), see them as whole people and not just a disease . I was working in the ER and was given D/C instructions for a patient after being seen by the medical person for hematemesis (bloody vomiting). The instructions consisted of a script for a PPI and a referral to a gastroenterologist. When I went in to discharge the patient, I saw he had fresh surgical scars on his wrists. I asked him about them and he explained he had carpal tunnel surgery three months ago. On questioning, it turns out he had been taking Motrin four times a day ever since. “The doctor didn’t tell me not to.” Further questioning of this 20 year-old determined he binge drank every weekend. The medical person never asked. This situation wasn’t even rare or unusual and he didn’t catch it. In this case we needed to know the cause to be able to treat the problem and prevent reoccurrence, this is where NPs shine because of being a nurse.
- “You think it’s because they thought nursing school would train them better to take care of patients? C’mon. It’s because nursing school is easier–as in, 10 times easier.” Since you never went to nursing school, you wouldn’t know, would you? Don’t make assumptions about things you know nothing about. Nursing school is difficult, maybe not as crazy as medical school, but that does not make it less valuable. We go to nursing school because we like the nursing model of health care. We are advanced practice nurses, not mini-doctors.
Nurses don’t impersonate doctors (oops, physicians), they are their own entity; complimentary to physicians, not replacements.
Now a word to Dr. Ablow: Do you feel threatened by NPs? What makes you so hostile? You are supposed to be a healer of the mind and emotional difficulties, yet you seem beset by your own insecurities to lash out so. Perhaps you need a consultation with a psychiatric nurse practitioner, they are well-known for their good listening skills, understanding and compassion.
Okay, I was fairly civil, for a Viking…Sigh, I hate it when I get mad, it never feels good afterwards.
What I never understood about the whole AMA opposition to the term “doctor” being used to address a DNP is this… We all had professors in the preclinical years who were PhD’s in microbiology, anatomy, etc. What did we address them as back in the day? What would we address those esteemed profs as today? The answers to both questions is “Doctor.” In spite of this, Physicians seem to have difficulty with anybody in a clinical sense being addressed as doctor. How do they address thier dentist?
Any physician who is afraid that he or she will be replaced by an NP should be replaced by an NP. I know I have a unique role in medicine and won’t be replaced by anybody. I am comfortable with my role and my skill. I’ve trained too many NP’s to count and will continue to do so as long as there is a need for instructors.
Kevin M. Windisch MD, FAAP (one of many types of Doctor, including PhD, DNP, PsychD, etc.)
Thank you, Dr. Windisch. I appreciate that.
I will subscribe to your blog. My first clinical will be in Peds and I have always worked with the older generation. A lot to learn!
I’ve got some pediatric physical exam technique videos including, hips, ears, chest, scoliosis and cranial nerves posted for students. They can be accessed via my facebook page “sparks pediatric and adolescent medicine”, my website http://www.sparkspeds.com or via youtube by searching for me. People seem to find these videos useful and anxiety reducing. good luck
Thank you for the informative post as well as kmwindisch for the wonderful videos.
Like anything in life, there are appropriate and inappropriate applications of skills. You don’t use a screwdriver for a nail and a hammer for a screw. For things like sinus infections and the like, I’ve often had better luck with NPs or PAs than with a lot of MDs. They weren’t so quick to brush me off and jump to erroneous conclusions treating me like cattle. Do I want a NP to treat my brother’s cancer? No. Would I be comfortable with a NP treating my mom’s hypertension? Absolutely. I think NPs, PAs, and DOs for that matter all get a bad wrap.
And I’m not sure what it is about the MD process but it either attracts or breeds a certain arrogance. I’ve overheard students only half jokingly say that pharmacists shouldn’t wear white coats, too. Maybe it’s because I’m a nontraditional student but I just don’t get it.
“Yes, medical school is rigorous and academically challenging, but so is nursing school.”
I’m sorry, FNP student, but medical school is far more “academically challenging” than nursing school. To claim similarity between the two is pure folly.
First and foremost, nursing school is shorter than medical school. When completed as part of a four year undergraduate degree, the nursing school component is three years in duration. For those who have previously completed an undergraduate degree, the BSN degree can be earned in two years. A nurse has spent 4 to 6 years in school beyond high-school to earn his/her BSN degree. A physician, however, has spent 8 years beyond high school to earn his/her MD.
Moreover, the breadth and the depth of medical sciences covered in nursing school is far less than that of medical school. Nursing school may be “challenging”, but medical school is an absolute ordeal. It is widely regarded as the most rigorous education of any profession. The training of nurses simply cannot be compared, year-for-year, with that of physicians.
On top of that, most of the content of your commentary is quite silly, and purely argumentative without any justification.
For example:
Your claim that physicians see people as nothing more than diseases while nurses are faithfully dedicated to whole of the patient is pure nonsense, and quite frankly, I’m rather sick and tired of nurses perpetuating that misonception. As physicians, we have a far greater responsibility to the well-being of our patients – professionally and fiscally. You can be damn sure that we spend as much time as possible (I emphasize the words “as possible”). When nurses-practitioners who have their own practices start to feel the kinds of pressures that physicians have to see more patients, you can be absolutely sure that they’ll limit their time with patients the way primary care physicians have.
Additionally, you said:
“You pay for anesthesia that is safe, and you get it. It is not relevant whether the one doing it is a nurse anesthetist or an anesthesiologist, they are both credentialed, licensed, and able to do the job equally well.”
Find me a major medical center that lets nurse-anesthetists (CRNAs) run the show. You won’t. Without exception, they all have anesthesiologists overseeing CRNAs. No hospital run by sane people would chose nurse-anesthetists over anesthesiologists. Some rural hospitals, unfortunately, are simply stuck using what’s available to them. I’m not an anesthesiologist, but I do know that there’s more to putting a patient to sleep than intubating and pushing drugs. Anesthesiologists are physicians. CRNAs are nurses.
And on a general note, your entire post reeks of immaturity and childishness. The logic and the prose itself reads like the work of a high school student.
Please differentiate between advanced practice nurses and RNs. There is a world of difference. I will also have been in school full-time for about eight years when it is all done and I sit for my ARNP certification exam. A master’s degree is the minimum now, and in 2015 it will be the DNP. We even use some of the same text books as physicians.
Read my list of courses and you will see that the breadth of the education is quite sufficient to provide excellent, basic primary care. Also, nurses are educated, not “trained”. That was a while back, when MDs still bled people to let out the bad humors.
It is a shame that some MDs, such as yourself, are so insecure that they need to call others immature and childish. Come out of the 19th century and see that ARNPs are a valuable resource; an adjunct to physicians and not a potential replacement. We happily concede that MDs have a tougher, more gruelling education, and we responsibly refer those patients who have need of your advanced skills. However, that does not mean that ARNPs are not properly educated and are not capable of providing excellent, safe and appropriate primary care for our patients. We are just as medically and fiscally responsible to them as physicians.
There is a lot more to a being nurse than taking a temperature and vital signs. It is about seeing and knowing the patient, counseling, and assessment skills. An excellent basis to build upon. Most physicians know that ARNPs are a great asset to the healthcare community and do not feel like they are “stuck with” them, instead they welcome them as partners in patient care, valuing the special skills that advanced practice nurses bring. Too bad for you that you are missing out.
I take my son to My NP (and she’s an FNP, not a PNP). I trust her more than any more of my, so called, fellow pediatricians in town. I know how much my NP does and does not know, I was her pediatric professor.
It is not about having put in the time. It is about what you know. If you spent 11 years after high school doing the minimum then you are licensed to kill regardless of your degree.
kmw MD, FAAP
As I sit here teaching my current FNP student I am becoming even more irritated with S Perkins.
Do you know why I don’t have any med students/FP residents at this point in time? I have a reputation with the local medical school of being too demanding of students. So the medical students avoid my clinic, choosing instead to go places where they aren’t worked as hard. At the same time, NP students from the same university are wait listed for teaching slots in my clinic. At the end of their respective programs who knows more about general pediatrics? I assure you, it is the NP’s I’ve taught not the Family Docs who steered clear of my clinic.
Who do you think I trust more? Who do you think I respect more?
kevin M. Windisch MD, FAAP
http://www.facebook.com/sparkspeds.nv
Associate Clinical Professor of Pediatrics (and Nursing) University of Nevada (Reno and Las Vegas)
“Many studies on the effectiveness, safety and patient satisfaction with NP care point to equal or better outcomes than physician care (I have the references if anyone wants them) in the specialities that the NPs practice in: pediatrics, family practice, adult, and geriatric, to name a few. NPs can and do provide excellent primary and specialized care.”
Ok, what are the references? Other studies have shown that NP take longer with patients (hence the greater patient satisfaction maybe?), order more unnes tests than physicians. Also, the studies showing higher satisfaction, and greater effectiveness are usually small sized studies carried out by allied health care professionals to further their agenda to gain more autonomy etc…I don’t think they are worth the paper they are written on.
“As to the right to be called “Doctor”. Doctor is an honorific for someone who has reached a doctorate level of education in any field, Dr. Ablow confuses this with the role of physician”
I have no problem with nurse practitioners calling gaining the title Doctor. However, I feel that use of the title within a hospital setting gives the implication that they are medically trained; this is the same for chiropracters etc. And it is misleading.
“NPs are a resource for good primary care in a time of shortage of primary care MDs, and a great adjunct in the health care team as a whole. Many patients prefer the NP so money is not the issue. NPs are not trying to replace MDs.”
Ok, but the gold standard is a physician. Regardless how you look at it; in the best possible scenario you would want a physician.
“Yes, medical school is rigorous and academically challenging, but so is nursing school. Getting into nursing school is tough, many schools have waiting lists of over two years. ”
Having started a nursing degree and completed a medical degree I can assure you that the nursing degree didn’t come close to the content and level of knowledge of an MD program.
“I myself started as an EMT, then got a Nursing Diploma (3 years with many, many clinical hours), then got a BSN, (3 years with more clinical), now I am enrolled in a MSN-FNP program (3 more years and 700 hours of clinical time).”
Ok so thats a total of 3 + 3 + 3 = 9. Compared to 4+4+3+fellowship = 13.
However, the difference is, the only training in diagnostics you have received is the last 3, whereas the MD has completed 4 years of medical school + 3 years of residency (possibly more) + 2 years of fellowship…Hence, the equivalent of your TOTAL training in diagnosistics, whereas a small portion of yours has been dedicated to it; how can you surely consider yourself equivalent based on that? I think it the height of arrogance to think you are the same as an MD with a fraction of the training.
“I was top of my class every time I went to school, and have a 4.0 right now (and it was not easy!) I suspect most nurses who go the extra time and effort to be NPs are intelligent, hard-working, and driven to help patients. As to physicians having more ”raw intellect” than the average nurse – aren’t we a tad arrogant, Dr. Ablow? I’ll match my IQ to yours any day and blow you out of the water.”
Ok good for you. However, arrogant Dr Ablow is; he has a point. I’m not implying that every doctor is smarter than every nurse, however based on the rigours of medical school and the requirements, I think the average doctor is likely to be smarter than the average nurse.
“Many rural hospitals don’t have anesthesiologists available, and would not be able to provide surgical and anesthesia services without CRNAs.”
Exactly, the CRNAs are there out of requirement. Regardless how you look at it, most hospitals would want the best trained to give anaesthesia. And that would be the anesthesiologist. Its the difference between competence and being an expert; and I really don’t feel that a CRNA with 2 years training is equivalent to an MD with 4 years of med school + 4 years of residency + fellowship. Sorry. I know that people argue that nurses spend 1 year in ICU etc; however that isn’t in a decision making capacity, you are pushing drugs that are requested by the physician. I appreciate its stressful etc, but ultimately in ICU the nurse isn’t making the decisions.
“ecause the idiots in Congress only listen to the lobbyists who give them lots of money, i.e. the AMA (which only represents 25% of physicians, by the way).”
Please nursing lobbying groups are some of the most effective in the country! Also, I’m sorry but I’m sure that the 3 years of NP training prepares you to spot the common stuff; but I don’t think 3 years is enough time to spot the rare stuff. Again, 4 years med school, 3 years residency + fellowship.
“Because they wanted to be nurses. Nurses are closer to patients (in general, there are always exceptions to the rule, my own MD is a good example), see them as whole people and not just a disease .”
But you aren’t acting in that capacity as a NP! Do you not see that you say you are nursing; however you are acting in a psuedo doctor role. You can call it what you want, but your role is closer to a physician.
Also, the physicians see patients as a disease is such a nurse like argument; and most of us don’t.
“was working in the ER and was given D/C instructions for a patient after being seen by the medical person for hematemesis (bloody vomiting). The instructions consisted of a script for a PPI and a referral to a gastroenterologist. When I went in to discharge the patient, I saw he had fresh surgical scars on his wrists. I asked him about them and he explained he had carpal tunnel surgery three months ago. On questioning, it turns out he had been taking Motrin four times a day ever since. “The doctor didn’t tell me not to.” Further questioning of this 20 year-old determined he binge drank every weekend. The medical person never asked. This situation wasn’t even rare or unusual and he didn’t catch it. In this case we needed to know the cause to be able to treat the problem and prevent reoccurrence, this is where NPs shine because of being a nurse.”
This is where a NP shines because of being a nurse. Thats a load of shite and you know it; this isn’t about you shining, its about the other doctor not completing a thorough history and examination of the patient. It has NOTHING to do with being a NP; all you’ve done is taken a proper history and examination, its hardly a rare diagnosis. This reflects more on the piss poor physician than as you as a diagnostician.
“on’t make assumptions about things you know nothing about. Nursing school is difficult, maybe not as crazy as medical school, but that does not make it less valuable. We go to nursing school because we like the nursing model of health care. We are advanced practice nurses, not mini-doctors.”
I’ve been to both; and nursing school, is much less academically challenging and requires less time input. I’m sorry, but medical school was an extreme culture shock for me.
You may like the nusing model of health care but you practice closer to the physician model; sorry but you may not be mini doctors, but you are psuedo doctors.
“Perhaps you need a consultation with a psychiatric nurse practitioner, they are well-known for their good listening skills, understanding and compassion. ”
I’m sure you can whip up a study showing this as well…
More of the same….I guess this debate will never stop.
In time, the physicians with this attitude will be left in the dust, like the dinosaurs who thought women couldn’t be doctors. Nurse practitioners are here to stay, we do a great job and we are valuable. If you want to stay in the past, go ahead, no skin off my nose. I am in a good mood today and choose not to engage in further debate on this subject. I will just go on and do my job. I will however, give you a couple of studies which you will probably ignore as they don’t fit in with your world-view.
Obviously, you will argue with any study organized by an NP organization, so how about this one in JAMA:
http://jama.ama-assn.org/cgi/content/abstract/283/1/59
Or one sponsored by the Florida Senate, where NP prescribing priviliges have been stonewalled for years by the FMA in spite of the report’s conclusions:
Click to access InterimReportPrescribingControlledSubstances.pdf
Here’s a report on the use of NPs in a VA facility for medical and psychiatric care:
http://archpsyc.ama-assn.org/cgi/content/full/58/9/861
That’s all I feel like doing right now, I need to go study my Harrison’s. Have a great day!
Harrisons, exactly a medical text book. Yet you are practising nursing? Mmmmmmm….
If it went to court, I think Nurse practitioners would have a hard time justifying what they are practising is nursing and not medicine, and that they should be answering to the medical boards and not nursing. To me nurse practitioners are just practising medicine without a license. Similar to the CRNAs pain management in Louisanna.
Also, you can throw as many small limited scale studies at me as you like, at the end of the day the only way you will convince me that a nurse practitioner and MDs care are equivalent are when you have completed med school, the USMLE, residency and board exams. Till then you are meerly a wolf in sheeps clothing.
Actually many NPs have been taken to court by people like you, and they always win. Also, in many states NPs practice under both nursing and medical boards. Get a life Jamie.
FNP….
You are silly. Most of the nurses I know do not even have the logic to work through a prerequisite course for medical education like organic chemistry or physics… Let alone apply physiology to disease processes. Your claims are completely laughable. the only claim you can really make is that a NP is better than a physician in an instance when a physician simply does not exist to provide care.
It is sad when someone feels so threatened by another that they have to sling words like “silly”. I am not so insecure as to feel the need to defend myself or my position in this case. Chances are, the nurses you are acquainted with are choosing not to reveal what they know to you, as you are probably the type to snub them if they did use their expertise in front of you. The people who lose (if you happen to be a physician, which is implied in your comment) are your patients.
As to physicians having more ”raw intellect” than the average nurse – aren’t we a tad arrogant, Dr. Ablow?
His statement is right on. I’m not threatened. I’m annoyed. Don’t act like nurses are innocent and doing the best things for patient care.
It is completely laughable that nurses can provide the same level of care as physicians. Ask an advanced nurse for a differential on most anything, and I’m willing to bet that most every physician can develop a longer differential…. Sure, the NP differential is sufficient most of the time- and that’s great for 97% of cases. But you see it’s the other 3% of cases that separates physicians from advanced nurses.
Okay, Bob. Last reply. You may continue to comment ad nauseam, I have better things to do. What is laughable is your use of a You-tube video to justify your b***t.
FYI: unless you are trying to impress a medical/nursing school instructor with your long list of differentials, the only differential that counts is the right one. So, it is not the length of the list that counts, but the accuracy of the diagnoses in it.
FNP student consider the following scenario I ran into at least 20 different times during my training.
Well trained athlete has to be an inpatient overnight. Nurse on staff observes that patients heart rate has fallen below 50 and nurse becomes very nervous, calls resident. Resident asks nurse how patient looks… nurse says she thinks patient appears oxygenated. Nurse calls again out of worry about HR. Resident comes in, looks at patient, observes patient is fine and leaves. Nurse calls attending physician to complain that resident did nothing…..
Anybody who actually understands physiology instead of memorizing numbers would know that the patient was absolutely FINE.
Now I’m not going to say that nurses haven’t saved me from making mistakes before. They certainly have. They’re an invaluable part of the healthcare team, and I actually think that there needs to be better communication btwn physicians and nurses. I’m just a bit annoyed because I just don’t think that nurses can replace the role of physicians like what they’re lobbying for w/ so many of the specialty fields in nursing. Do I want what’s best for the patient? You bet. Do I think that involves a team effort? Yes. Do I think physicians alone can do it? No. Do I think the answer to the physician shortage is to give nurses more autonomy? No, because I think that in the end this will result in harm to patients. However, given how dramatic the shortage will be, it seems as though this might be society’s best option.
There are bad nurses and good nurses, just like bad physicians and good physicians. I am perfectly aware of the fact that athletes tend to have lower heart rates, as most nurses I know are. I also sent a patient back to the hospital in the same ambulance he arrived in after the ED had sent him home with a (peripheral) pulse of 80 and an apical rate of 160. Another patient at home had severe hypotension (among other symptoms duly described to the MD) and when I called the MD he wanted to half her Norvasc dose, I insisted she go to ED because I could see she was having an MI. MDs aren’t the only ones with eyes to see and the knowledge and experience to help our patients. NPs and PAs are perfectly capable of providing excellent primary care, and/or specialty care in their area of education and expertise.
” NPs and PAs are perfectly capable of providing excellent primary care, and/or specialty care in their area of education and expertise.”
To a certain extent, sure. The concern lies in these individuals recognizing their limitations, which is a difficult thing to do. You also have to consider the rate at which MDs have to think about cases. Ok, compared to nurses and PAs, MDs have significantly less time to think through everything that’s going on. A nurse anesthetist is NOT as capable as an MDA, trust me. Sure, they are capable of handling a good majority of cases, but you see, a good majority just doesn’t cut it when people’s lives are on the line.
“You pay for anesthesia that is safe, and you get it. It is not relevant whether the one doing it is a nurse anesthetist or an anesthesiologist, they are both credentialed, licensed, and able to do the job equally well.”
This statement pretty much of the way summarizes the opinions of those in the specialized fields of nursing. You don’t even realize what you don’t know, so how are you going to practice within your limitations?
“FYI: unless you are trying to impress a medical/nursing school instructor with your long list of differentials, the only differential that counts is the right one. So, it is not the length of the list that counts, but the accuracy of the diagnoses in it.”
If you can’t even think up what could possibly be wrong with a patient, then how would you treat the patient? The length of the list does matter because if you don’t keep the rarer causes on the radar screen then you will miss cases, and patients will lose. big time.
FNP
how many nursing programs does the university of phoenix online offer? How many online nursing programs are there?
How many medical schools are there online?
FNP student,
I had written a similar response to Dr. Ablow and posted it on the DNP online community: http://www.doctorsofnursingpractice.org/ Seeing the comments by the MD’s always makes me sad/angry/irritated… and more. I have many comments so I will apologize for the rant/response in advance.
I believe that NP’s and PA’s are valuable parts of the care team and that we are capable of providing high-quality care collaboratively and/or independently and we do know what we don’t know and when to refer. Well said in many comments we are not physicians we are nurses and while we diagnose and treat we also apply nursing concepts first.
I think the comments by kevin M. Windisch MD, FAAP were great. NP’s have (in many cases) shown a long term commitment to learning and are not afraid of the tough conversations with patients or the tough clinical experiences.
I was also irritated with the person who asked about online nursing graduate programs – there are few online NP programs but many require time on campus and ALL require clinical hours. Also there is evidence that medical schools are (going to have to/are) learning to adapt their educational models because there are not enough MD’s graduating additionally, the lack of MD students lowers the standards of the students because of basic economics, for schools to run they have to have students and medical schools get lots of funding to keep students graduating. Lastly, many foreign MD’s have less rigorous programs than the US medical schools and some do not even earn bachelors degrees they are strictly medical training that in many cases is less education than I will have as a DNP.
Okay, I will stop… thanks for your posts. Really enjoyed reading your thoughts. I hope you continue on with the DNP.
audra, I agree with everything you said up to the point about med schools lowering their standards. I’m not sure about other states, but Texas med schools have been becoming increasingly competitive with average matriculating MCAT scores, GPA, etc getting higher and higher. It’s not for lack of qualified applicants. It’s lack of funding to train the students but that’s a whole different issue.
Jamie – since when do ALL physicians complete a fellowship? Don’t generalize that time into every physician’s education time table. It is simply untrue.
To all physician responders – NPs are out there to help YOU! As an NP in the ED, I am well respected among my colleagues and MUCH appreciated! By seeing the sinusitis patients, suturing the lacs, draining the abscesses, etc., I free up the physicians to focus on the strokes, the major traumas, the MIs — the TRUE emergencies. No one needs to argue about who had the more rigorous and in-depth education. I will readily admit physician training is more rigorous (my husband in an MD) — and that is great! Their education enables them to tackle those complicated cases! The take home point is that we need to respect and appreciate everyone’s part in the health maintenance of our patients.
As for Dr. Ablow – I would never be so naive as to compare my training with physicians, but it is truly insulting and ignorant on his part to be bashing the nursing profession and acting as though we don’t have a strong impact on patient care.
And the beat goes on….and on…….and on…..
I am not a physician, nor am I an advanced practice nurse. I am just a “little nurse” with an ADN. I guess I should be gratefull that I am even trusted to take a pt’s BP and HR.
I am so frustrated with healthcare right now it makes me sick. The focus seems to have shifted from providing quality medical care to money, or maybe it’s allway’s been that way….I can be very naive.
The subject of rural practice and the fact that hospitals have to get by with what they can get…hmmmm…I wonder why a rural hospital would have such difficulty in finding an anesthesiolgist. Is it because they are so rare, or is it because they are ranked # 11 in the top 50 best paying jobs (CNN Money), and are less likely to be paid their weight in gold (since physicians are the gold standard) in a rural setting?
What irritates me right now is that I cannot provide my pt’s quality care. I am expected to get their weight, BP, HR, go through their medications, go through the Q’s on the intake sheet and clarify the reason for their vist, all in less than 10 min. period. No exceptions for pt’s in wheel chairs, Pt’s who are confused, pt’s who bring along the entire family, pt’s who require an EKG or pt’s who don’t speak english. Oh, lets not forget the wheelchair bound pt who sudenly needs to urinate once you have them correctly positioned in the exam room. When it comes to evaluation time all that matters is how long did it take me to room the pt. We recently had a pt who had been seen in our clinic 3 times for SOB secondary to CHF. She had more medications listed on her med list than most pharmacies would carry. I went through all her medications one by one. Dose, frecuency ect. She answered yes to every medication. Upon leaving the room I was reviewing the paperwork and remembered she also had a Dx of COPD. I had a feeling I should double check to make sure she was taking the four medications she had beeen prescribed for this condition. She was taking them, but only as needed. As it turned out she had not needed them for 2 years. Nore had she followed up with pulmonary. As it turns out the rest of the appointment was focussed on medication compliance, refilling and starting her pulmonary medications and arranging a pulmonary consult. But at the end of the day there was a problem, I am taking too long to room the pt’s. Funny how this minor piece of information had been missed untill I brought back the pt. Funny how I never make nurse of the month. Funny how I am seen as a problem, not a solution.
Seems to me that when it comes to providing healthcare everyone has there head up their rectum. We have Drs running arround thinking their God and the nurses are so micromanaged and overloaded they can’t do their job, not if they want a good yearly evaluation (or want to keep their job)
Pt’s are people with lives, feelings, emotions and families and quite frankly we treat them like shit. They don’t know what quality healthcare is and we fool them with a warm hand shake and a smile.
I don’t care what a persons IQ is. I don’t care were they went to school nor for how long. What makes a good clinician is someone who has the desire to learn and time and practice. Medical school does not teach someone to be a good Dr. and nursing school does not teach how to be a good nurse, thats up to the individual to decide throughout their carrier.
What we need to do is define what quality heathcare is, shift our focus back to the pt and set goals to ensure that we continue to provide quality care. We need to take a look at what it means to have mutal respect and set standards that enforce that definition so that Drs and nurses can work in partnership. And all healthcare providers should be able to practice to the full extent of their capability. The atmosphere in healthcare is so toxic I wonder why we put up with it. When a nurse has to go to another nurse and ask if she should call the Dr. who wrote an order for 500 mg metoprolol, IVP, q2hrs for a HR > 20, or if she should diregard the order, but document it as being followed, or just follow the order, but make sure the code blue team is standing by….it’s just rediculous. Drs are human and make mistakes and nurses are not stupid. I would not want to take away any credit from someone who graduated med school, lets face it that is a huge accomplishment. But does that mean that someone who is not an MD is stupid. Does it give you the right to yell and shout at someone without an MD. In the current healthcare culture it does! and it is not conducive to pt care!
Given the oportunities that healthcare has to offer, why is there a shortage of Drs or nurses. Somewhere along the line something is wrong. Why is it that we cannot provide enough Drs or nurses to meet the needs of our society…that is the question!
And if anesthesiologists are not able to meet the needs of rural America, lets be grateful that nurse anesthetists can. They seem to be doing a great job!
Okay, Jonathan, take a deep breath. I feel bad for you and I’m sorry you are having a difficult time of it. Been there, done that. Try to focus on why you are in nursing, and try to find a path through the “stuff”. Unfortunately, there is a lot of “stuff” to deal with, but it takes a positive outlook to wind your way down the path. Of course, there is the money issue, that has always been there. Of course, there are numerous onerous regulations and rules to follow. Everybody in health care is dealing with it, but the way a person handles it can affect everyone around them in a positive or negative way. If you find it all so difficult and frustrating that it makes you sick, it is time to re-evaluate where you are. If the culture at the job you are in now is so poor and angry, maybe it is time for a change. Perhaps some of the frustration you are feeling is feeding the negativity. Being a duck can also help (let the stuff roll off your back, things will never be perfect), and try to project in your own dealings with people, the way you would like it to be. Leading by example is always good, and helping others to find solutions to problematic things in a nonconfrontational way(You know, maybe if we did this and this, that would help solve this particular problem). I hope you can find fulfillment and peace in your career.
The nurse practitioner almost killed a patient today….oops!!!!! Guess he should have seen a clinician that didn’t get their degree from University of Phoenix
Real nice. I wasn’t even going to respond, but University of Phoenix doesn’t even have an NP program. Pinhead. Edmund, so you are a medical student, you love to feel superior evidently, like many other medical students who make comments here. Please read my post MDs vs NPs.