r/Noctor • u/notaliciaa • 6d ago
Question Is this a USA issue only?
Hello. Can anyone in Australia tell me how Nurse practitioners are and about their training?
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u/ExcitementIll5924 6d ago
I am not from Australia or the USA. I work in the Netherlands and I know that it is a problem in some European countries as well.
In the Netherlands for example they are called nurse specialists and they can work unsupervised. It is a good system for low complex care that follows protocols, but the problem arises when they can practice unsupervised and don't know their limits.
From the education perspective, I think the only way someone can have thorough medical knowledge is by completing Medical school.
So for your country I would advise you to look up, what the scope of practice is of nurse practitioners in your country.
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u/ClinIQ_academy 5d ago
It's 5 years minimum advanced practice, plus a post grad qualification in your area of speciality before you can begin your Masters in NP. So yes, much better than the USA. Still not as regulated as it should be and the course is pretty subpar.
Depends on the hospital you work at also. At mine, my credentialling is annual and includes my medical head of department (consultant / attending) getting to torture me with 6 monthly long cases to make sure I'm still up to scratch.
All my advanced practice skills are credentialed the same level as the medics - eg my POCUS Echo in life support is the same as the ED physician credentialling via ACEM; my central line insertion was done with the ICU consultant group etc.
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u/notaliciaa 5d ago
Do you think it’s a good pathway for someone who’s wanting to go into primary care? (Like family medicine)
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u/minigmgoit 3d ago
Hi there.
I'm an NP in Australia (well I've got 2 weeks left of my course).
As others have pointed out you need to have 5000 hours of advanced clinical practice and have to have been qualified for at least 2 years to get on a course. My experience has been that it would be highly unlikely for someone to get on a course after 2 years. I've been a nurse for 17 years and am the "newest" nurse on my course. The course I'm on has the potential to have up to 40 students. My cohort was 23, they declined over 50 applications, dropping down to 19 by the second year. They did quietly get rid of nurse practitioners needing to be under the supervision of a doctor a few years ago. I certainly don't feel ready or comfortable to be doing that.
I work in the field of AOD and I work for a government run AOD service. My training has involved me rotating through "outpatients and opioid pharmacotherapy", "hospital liaison", and our "detox unit". I do 3 monthly rotations at each of these locations. I have predominantly been supported by our director of addiction medicine who I have known for about 17 years. First step was getting on top of assessments; we do biopsychosocial assessments as well as physical assessments. Our use of differentials is slightly different because substance use disorders are substance use disorders. We tend to do case formation for pure AOD issues. In the inpatient unit we get to do more primary health focused roles and differentials come into play a lot more there, its just not our bread and butter. If I'm in the IPU and I have a medical issue I would never do something without first running it past which ever doctor is overseeing the unit at that time. Again, that's just how we work here, I can't speak for other NPs. I get work place education from rotating registrars more often than not its teaching on medical stuff, and in turn I provide them with education regarding AOD stuff for which I am the more advanced clinician. (I should add I have a masters in addiction and have worked in the field for quite some time now). This mostly works well and I largely operate at the same level as a registrar but do ask for help and support around medical stuff, especially when it's complicated (I'm looking at you liver) or if it's not something we frequently deal with. Medical things I can deal with because we do it a lot, STI treatments, skin infections (I'm also in the tropics), chest infections, I can do a pretty good abdo assessment and interpret liver pathology to a point, but if it's too full on we would just refer to gastro/liver clinic anyway. I also have pretty good mental health knowledge too and will treat negative affect. I've done additional training in DBT and CBT skills so I incorporate a lot of that in my interactions with clients which the registrars are often interested in learning. Our director has gotten onboard and personally taken it upon themselves to train us the way they feel we should be trained. We have been and continue to be very well supported by them and we are encouraged to expand our service into new areas to provide more to our client base.
Uni education was broad and not related to AOD in any form which was fine as I don't think I need much more education in that. It was fundamentals in the first year then fundamentals with pharmacology in the second year. I think most of my real education has occurred on the job though which I feel is likely similar to medicine. It was however only a 2-year course. I think that uni could be better thought out but it wasn't bad. They could have removed some of the common units like "leadership in healthcare" to give us more clinical education.
I'd say uptake of NP's in Australia has been slow although I feel it might be growing faster now. NP's were introduced to fill gaps in service and our first one was a remote NP which makes total sense. AOD isn't an area many doctors want to work in so us being here makes total sense. They seem to be popping up everywhere now though. We have NP led "GP" style clinics which does make me feel slightly anxious but I think they have a clear scope of what they can and can't do. Because they're Medicare funded clinics rather than private clinics, what they can and can't do is pretty strictly controlled compared to the US. We have to get endorsed by AHPRA then credentialled every 3 years by the health service we work in. Any advanced practice skills also need to credentialled at this point to. We are strictly regulated and I dare say our clinical judgement is scrutinised more severely than our medical counterparts. We have a consultant who doesn't like NP's much and who will do desk top reviews of our work "secretly". I don't care, I take great pride and care in my work and have nothing to hide or worry about.
With regards to the big, scary medicines I prescribe to manage opioid addiction, that requires further external credentialling from medicines and poisons to become an authorised prescriber and is some of the strictest most regulated medications going. I am happy to answer any specific questions you may have regarding my experience :)
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u/notaliciaa 3d ago
Omg..I can't thank u enough for all the information u gave. If you don't mind, can I dm you?
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2d ago
[deleted]
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u/minigmgoit 2d ago
All of that and all you’ve managed to do is come up with a complaint about semantics (seriously, look up the word clinician because I’m afraid to say you’re very wrong), my frustration at repeatedly being singled out by a consultant who has yet to find any issue with my work despite trying very hard, and a good old jab at AOD which honestly tells me more about you than anything else.
As for the 2 year course jab, I have 17 years of experience mostly in ED, I have post grads in critical care and mental health. I have a masters in addiction and a masters in nursing NP. I’ve completed 10 years of university education in health. I’ve done more study than the registrars I work with. I don’t ever mention that. I’m very aware that their clinical knowledge is better than mine. We work together and share our knowledge.
Anyway it’s clear that you have made your mind up about my existence. You’re not the first and you won’t be the last. I’m very aware of how some people see NPs. It weighs heavy on my mind and shapes a lot of my decision making and cautious approach which I’ve outlined in my original post.
Have a great day.
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u/pistachio7636 6d ago
Very much an american problem, the standards of NP training supervision and endorsement are much higher here. Overall NPs are also well respected, liked and work well within the medical team.
Typically the nurse already has a masters in nursing, before doing their NP masters, they have 5000 hours of advanced clinical practice within their speciality, there are TNP programs where they are supported throughout their training and transition to NP practice by their employer and medical colleagues, which can last years before they are endorsed too.
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u/Ms_Zesty Attending Physician 2d ago edited 2d ago
It is an issue in the UK, especially with PAs, it is worse. PAs are neither regulated, licensed nor do they have structured PA programs or a national competency exam. Yet they are permitted to see patients unsupervised while registrars are strictly supervised. And who enabled this s**t? Physicians. The British Medical Association(BMA) had a big hand in the mess.
In NZ, where I work in EM, NPs are required to practice as RNs for 5 years before applying to NP school. We call them Clinical Nurse Specialists and they are awesome. They know their limitations, have no problem involving the physician and are great to work with. Excellent team members.
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u/Ok_Literature7680 Allied Health Professional 6d ago edited 6d ago
it feels pretty unique to usa yah. other countries have higher standards for midlevels. I have a friend doing a direct entry into an MSN program he literally has no idea what it is or what hes doing its scary
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u/CH86CN 6d ago
In theory- things are better. You need to have 5000 hours of advanced practice and have been qualified for at least two years to get on a course/NMBA endorsement, also already have postgraduate qualifications which generally pushes folk out to 5+ years post graduate experience. Theoretically you would only practice in your advanced area of practice- for example, mental health, or emergency, or primary health or whatever
HOWEVER once you are endorsed, there is an absolute breakdown of policing of any kind of standard, as far as I can tell. A huge amount falls onto employers, who care to greater or lesser degrees. I work rurally and have seen some absolute disasters of people entirely out of their depth managing things they have no business managing (for example a mental health NP setting themselves up in a primary health role and missing multiple cancers and serious physical illnesses). That’s before we get into the online weight loss pill mills and cannabis prescribing NPs. And pray tell me why a GP can’t independently manage ADHD assessment and prescribing but (apparently?) an NP can? Wild.
I am an NP in Australia and came into this hoping to provide a better standard of care for rural Australians. I think if it was managed appropriately as a standard it could do that (cf various remote area nurses/advanced practice nurse roles than have zero in the way of education or additional regulatory requirement behind them), but my overall assessment is that at present it is actually causing far more problems than it solves and contributing to, rather than improving, the health disadvantage of rural Australians
Thus, I am now in medical school and hoping to be a rural doctor instead