NYT: Nurses aren't doctors

[Poatan Power]

I got my bachelor's from UT Houston (the school attached to MD Anderson). I have worked with adults in a trauma/surgical ICU with Medical overflow patients and I currently work in critical care in a top pediatric facility.

That's awesome. My sister has worked in PICU/NICU at a Magnet hospital, you guys do great work. I like dealing with adults myself.

 

[nhbfan8080]

Is the NP position something of a sidegrade from the PA (physician assistant), so the NP graduates out of nursing school while a PA has sortof completed half an MD program?

 

[SeefourDC]

Is the NP position something of a sidegrade from the PA (physician assistant), so the NP graduates out of nursing school while a PA has sortof completed half an MD program?

PA's and NP's are similar and yet very different. They occupy a lot of the same roles in many facilities but the reality is PA's are at a disadvantage clinically to start. Whereas a nurse practitioner usually has a lot of bedside experience dealing with real hospital issues many PA's do not at the start of their programs. You can basically apply to PA school with almost any degree. I've heard that they do consider some other health care related fields but the reality is nothing really beats the knowledge you get from nursing, especially in a critical care area. A few PA's will have backgrounds in respiratory therapy but outside of that you get all sorts of things. Bio majors, biochemistry majors, Biomedical engineers. All sorts of stuff. Don't get me wrong, we also have great PA's where I work but they face an uphill climb due to lack of clinical knowledge when they start out. In many ways they are acquiring the same knowledge but the big difference is nurses are generally building on a solid foundation from a year, two years or more experience from their clinical work experience on top of their previous healthcare education. PA's get great educations just like any advanced license practitioner, but it's tough to go into the medical field at an ALP level. I highly respect the PA's I know because they had a big hurdle to overcome.

Make sense?

 

[New User 122121]

Is the NP position something of a sidegrade from the PA (physician assistant), so the NP graduates out of nursing school while a PA has sortof completed half an MD program?

I think most physicians would probably agree that PAs have far superior training. Their school, like you said, is more like the med school model. They typically spend over a year working side-by-side with medical students in the hospital and finish school with thousands of clinical training hours, which is several times more than a typical NP/DNP would get.

If you want to talk objectively, by the end of 3rd year, med students and PAs have infinitely more basic science knowledge and many times the number of clinical training hours than any NP/DNP program in the US offers.

Prior experience as an RN starting IVs and handing patients cups of pills is not as useful as some people would have you believe. If you browse the nursing forums, a lot of nurses use this fact to justify direct-entry programs (where you become an NP/DNP within a couple years, no prior healthcare experience needed. The number of clinical hours of training required often ranges from 600-800ish, which can sometimes be completed completely online (wtf!?), and many programs do not provide preceptors--rather, the student has to seek them out themselves, which means clinical training of questionable quality.)

No one would trust a 4th year medical student to make important clinical decisions. Why would anyone think it's ok for someone with much less training to do so? I would never hire a NP over a PA out of principle, and I know I'm not alone in this sentiment.

 

[Poatan Power]

I think most physicians would probably agree that PAs have far superior training. Their school, like you said, is more like the med school model. They typically spend over a year working side-by-side with medical students in the hospital and finish school with thousands of clinical training hours, which is several times more than a typical NP/DNP would get.

If you want to talk objectively, by the end of 3rd year, med students and PAs have infinitely more basic science knowledge and many times the number of clinical training hours than any NP/DNP program in the US offers.

Prior experience as an RN starting IVs and handing patients cups of pills is not as useful as some people would have you believe. If you browse the nursing forums, a lot of nurses use this fact to justify direct-entry programs (where you become an NP/DNP within a couple years, no prior healthcare experience needed. The number of clinical hours of training required often ranges from 600-800ish, which can sometimes be completed completely online (wtf!?), and many programs do not provide preceptors--rather, the student has to seek them out themselves, which means clinical training of questionable quality.)

No one would trust a 4th year medical student to make important clinical decisions. Why would anyone think it's ok for someone with much less training to do so? I would never hire a NP over a PA out of principle, and I know I'm not alone in this sentiment.

Stop talking. You know jack shit about any of the things you are posting, as evidenced by the bold. Thank you for failing to mention that "completely online" programs have hundreds of mandatory clinical hours under the guidance of an MD that you must have in addition to your regular employment. Programs like this are offered by questionable universities such as Georgetown -_-

Furthermore, I inherit critically ill patients in hypotensive shock and work without an MD for several hours before they come to assess the patient based on evidence based practice protocols. Your assessment of a typical med-surge RN who works in an extended care facility is hardly descriptive of nurses as a whole, like myself, in their 6th year of education in addition to their clinical experience in several environments.

Happy Nurse's Day.

Is the NP position something of a sidegrade from the PA (physician assistant), so the NP graduates out of nursing school while a PA has sortof completed half an MD program?

Sort of. An RN has to get an RN license (2 years of RN school) and at least a BSN (add another 1-2 years) in addition to a NP training program (another 2 years). You can't just go to nursing school and be an NP -- both PA's and NP's need a BA/BS before getting the PA/NP training.

 

[New User 122121]

Stop talking. You know jack shit about any of the things you are posting, as evidenced by the bold. Thank you for failing to mention that "completely online" programs have hundreds of mandatory clinical hours under the guidance of an MD that you must have in addition to your regular employment. Programs like this are offered by questionable universities such as Georgetown -_-

Furthermore, I inherit critically ill patients in hypotensive shock and work without an MD for several hours before they come to assess the patient based on evidence based practice protocols. Your assessment of a typical med-surge RN who works in an extended care facility is hardly descriptive of nurses as a whole, like myself, in their 6th year of education in addition to their clinical experience in several environments.

Happy Nurse's Day.

Since you were still taking your nursing classes at the local community college last year (6 years of education? Are nurses counting high school now?), you most likely missed the hoopla a few years back about the entirely online (including clinical training) DNP degree. The link I used to reference is dead now, but a cursory search here on my mobile device shows me Rush is offering DNPs with "specialty certifications" requiring a whole 620 hours, including "online clinical supervision". Giving someone a prescription pad and free reign after only 600 hours of practical training, some (or possible still all?) of which can be completed online, is genuinely terrifying.

 

[JuliaB4GSP]

I've only had a couple patients ever ask about my medical school or residency. In the real world, patients come to you by referrals from friends or other physicians. The only people who care about what medical school you went to are pre-meds and narcissists who think attending a big named school matters. And for those patients, they can go to those doctors. They need each other.

That's fine, I know a bunch of people who go to chiropractors and say they're the cat's pajamas too. DO's are still spending time studying pseudoscience, whether it's a few semesters or years.

 

[hoonosewot88]

I'm a med student, will be qualifying in a couple of months, and i have absolutely no problem with NPs. Here in the UK they're becoming increasingly common, and they can be a lifesaver for taking pressure of the docs by dealing with the simpler cases.

Whilst you do need the training a doctor receives to deal with the truly complex stuff, NPs are very knowledgeable and well trained in their own right, in fact, their years of experience dealing with certain conditions makes them better at dealing with those conditions than many junior doctors who simply haven't got the experience yet.

The sad part of this debate is that people seem to think they need to side with either nurses or doctors and disparage the other. The reality is that both do incredibly important jobs and are reliant on one another to care for patients fully.

Patient care is a team job, not a solo effort.

 

[New User 122121]

That's fine, I know a bunch of people who go to chiropractors and say they're the cat's pajamas too. DO's are still spending time studying pseudoscience, whether it's a few semesters or years.

That's true, but they teach CAM/pseudoscience at a lot of medical schools, even places like Harvard.

 

[Blackened]

Just no. Most PCPs are so busy that they don't look at anything other than what the patient is primarily complaining about. They don't catch the rare/complex things until it is painfully obvious.

Just look at it in terms of training even. [Going by the Canadian model that I know] PCPs have two years of med school training, two years of school/internship (where you a really more of just a passive observer), and two years of residency (one of which is essentially reliving the rotations they did in internship). That's six years total in training. NPs go through at least this amount, and usually have at least a few years of actual work experience on top of it all.

My girlfriend is a doctor, guess who she goes to see when she needs her prescription refilled or has a minor problem?

If your girlfriend was a doctor you should know there are no 2 years residence programs.

 

[Blackened]

They're both shitty analogies. A doctor is not a nurse and a nurse is not a doctor -- they're two different careers that collaborate for a common goal, but in a specialty area of nursing the two fields have overlapping scopes.

But, the other poster does have a point with the chef/cook thing. Doctor's scope of practice is threatened by RN-NP's increasing their scope. In other words, doctor's who have a salary dependent on RN-NP's being incapable of independence have an axe to grind to keep another herd from grazing in their fields.

Even if all the NP's and PA's were allotted their own independent practice, there would still be a shortage of physicians.

The reason troublesome issue and what is making me think twice is residency slots. The number is going to remain constant and the demand is going to increase.

 

[Blackened]

No one is saying that NPs are as intelligent or experienced as MDs. They aren't. So the MDs here can put their dicks back in their pants - the measuring contest is over.

But that's not the point - the issue is that lots of people are basically getting (a) either zero medical care or (b) crappy medical care under the current system because physicians think they should be allowed to spend 3 min with a patient, write an Rx and then bill for a $400 visit.

Patients and providers realize that you don't need a 7-figure a year rubber stamp for the vast majority of common ailments so they are seeking alternatives.

Medical schools could cure this problem with the stroke of a pen: just graduate more physicians. But then they wouldn't have (a) bragging rights of only accepting the top 3% of applicants (because God knows that 4% person could NEVER practice medicine) and (b) they couldn't cry for more money like the writer of this NYT article.

The author's solution to a lack of adequate healthcare care is literally pure comedy: pay us more and don't seek alternatives. Can you imagine a member of any other industry other than medicine saying something so infinitely stupid in a public forum?

The Medical schools are graduating more physicians. This is incorrect. The government needs to increase residency slots. Many new medical schools are opening, and the residency slots are remaining constant. There are many MD's and DO's that didn't make "the scramble" and have an MD/DO and aren't allowed to practice simply because they didn't get a slot.

 

[Anung Un Rama]

I'm a healthcare professional and the article isn't wrong.

There is a reason we have MD/DOs, DDS, RN/NPs, Pharmacists, PTs, PAs, etc.

We all have strengths that the others lack.

Its frustrating having to deal with the shortcomings of other HCPs, and it gets even tougher to accept our own limitations as we're all fighting for a bigger piece of the pie.

 

[Blackened]

I'm a healthcare professional and the article isn't wrong.

There is a reason we have MD/DOs, DDS, RN/NPs, Pharmacists, PTs, PAs, etc.

We all have strengths that the others lack.

Its frustrating having to deal with the shortcomings of other HCPs, and it gets even tougher to accept our own limitations as we're all fighting for a bigger piece of the pie.

What makes it really shitty on those of us choosing medical school is the debt (will be about 250k for me when all is said and done). If one gets stuck with a family medicine residency or choose psychiatry, we are in a long haul as far as debt goes. My interest is psychiatry and if I choose this I know I'll be financially much worse off than if I'd become a PA for the first decade or so post residency

 

[Bukowski82]

I'm a healthcare professional and the article isn't wrong.

There is a reason we have MD/DOs, DDS, RN/NPs, Pharmacists, PTs, PAs, etc.

We all have strengths that the others lack.

Its frustrating having to deal with the shortcomings of other HCPs, and it gets even tougher to accept our own limitations as we're all fighting for a bigger piece of the pie.

Very enlightening post.

 

[shunyata]

You're right. You don't necessarily need a doctor for simple conditions. A nurse practitioner can diagnose an ear infection. But you should see a doctor because he has the education to catch the bad stuff that you really worry about. NPs just don't have the training to catch the rare/complex things. And a lot of times they are not going to refer out because they don't know what they don't know. That's why they need supervision.

You are very clearly a professional internet poster. It could not be more obvious that the company you work for set up a discrete contract with the AMA and one of the topics you were assigned to was this.

 

[shunyata]

The Medical schools are graduating more physicians. This is incorrect. The government needs to increase residency slots. Many new medical schools are opening, and the residency slots are remaining constant. There are many MD's and DO's that didn't make "the scramble" and have an MD/DO and aren't allowed to practice simply because they didn't get a slot.

Which is particularly absurd when you consider that nearly every hospital in the country overworks residents to death (iatrogenic patient death that is) with shifts up to 40 hours and beyond.

The exhaustion and sleep deprivation drastically increases the incidence of medication errors, iatrogenic health problems, and ultimately death.

It's pretty well known in most ICU's that if you or a family member over 80 years old needs a colonoscopy, you do not want it done by a resident because the ICU staff ends up working on elders all the fucking time who have perforated bowels due to a resident performing a simple colonoscopy while sleep deprived and not terribly experienced (and having no concept of how fragile colon tissue is an 80 + year old elder combined with the mental and physical exhaustion brought on by overwork).


Yet we do not see hospitals going out of their way to hire more so that they can have residents work a rational shift of 12 hours or less.

 

[Amerikuracana]

Nurses are overpaid, and do not realize how good they have it just for going into that particular field. I like nurses, but they have the woman disease as a whole. They want to faction form and make life difficult for the Doctors, because they have the numbers, and simply because they have the ability to do so. FOCUS ON YOUR JOBS. I actually heard a nurse complaining about Doctors and their decision to have a diagnostic performed on me before a couple other people while they were taking me to the test. It was DISGUSTING. Bitchiness and its "power' is really hurting morale in America.

 

[Shartnado]

The main thing is too not mix medicines you shouldn't, and really any nurse can google that. Do you really think the Dr doesn't do the same thing? Its not like he stops at med school and knows all

 

[UpaLoompa]

If you want to risk using an NP as your primary healthcare provider, more power to you, but I certainly wouldn't. I don't know a single one subscribes to any scientific journals, let alone keeps up with the primary literature. The majority of what a primary caregiver does is prevent issues and catch them early, not deal with minor issues even though that is part of it.

While obviously you're going to want a doctor for a lot of things I think you're confusing ideal situations with reality. The 5-10 minutes you spend with your primary care doctor aren't going to lead them to prevent or catch much of anything. Glad the doctor got to me an hour late for that.

Also, the ability of most medical doctors to assess scientific information is on par with the ability of a warm turd to do the same.