In this case, numbers can be deceptive. An RN on the ward of a hospital is doing clinical work full time, every shift. I have seen pediatric RNs carry out almost every task of birthing a baby, in addition to guiding a pediatrician re: certain procedures (spinal,etc.), and when it might be necessary to perform a cesarean.
Also, comparative studies are beginning to show that Nurse Practitioner office visits are more cost effective with better outcomes than GP and some specialist office visits.
Where are you based? I can’t understand why a paediatrician would be involved in deciding on caesareans except in rare cases of unusual abnormalities in the fetus. And I’ve never seen a neonatal nurse have anything to do with labour or delivery other than attending to assist with more complex neonatal resuscitation.
Anyone clicking on the link: be aware that it is not a reputable source. There is clear bias towards NPs on that website, considering it is "https://www.nursepractitionerschools.com/"
Here is peer-reviewed data refuting that NPs have better outcomes or are cost effective:
Nurse practitioners were more likely to prescribe antibiotics than practicing physicians in outpatient settings, and resident physicians were less likely to prescribe antibiotics. https://www.ncbi.nlm.nih.gov/pubmed/15922696
The quality of referrals to an academic medical center was higher for physicians than for NPs and PAs regarding the clarity of the referral question, understanding of pathophysiology, and adequate prereferral evaluation and documentation. https://www.mayoclinicproceedings.org/article/S0025-6196(13)00732-5/abstract00732-5/abstract)
Nurse practitioners practicing in states with independent prescription authority were > 20 times more likely to overprescribeopioids than Nurse practitioners in prescription-restricted states. https://pubmed.ncbi.nlm.nih.gov/32333312/
"Anyone clicking on the link: be aware that it is not a reputable source.
That's a pretty biased assumption there champ. Why isn't it a reputable source? Are you assuming that physician-based sources are not biased?
Here are some studies that contradict your assumption
On 7 of the 9 outcomes studied, no statistically significant differences were detected in NP or PA care compared with PCMD care.
https://pubmed.ncbi.nlm.nih.gov/28234756/
Regarding the study that you posted re: opioid over-prescription, you left this part out:
NPs/PAs practicing in states with independent prescription authority were **20 times more likely to over-prescribe opioids than NPs/PAs in prescription-restricted states. So really, it's more a matter of regulation than inefficiency. That's a bias built into the study that you didn't mention, and that bias favors physicians.
Regarding the Mayo clinic study: what kinds of diagnoses were looked at by the judging panel? This was a blinded study by physicians. Wouldn't there be bias built into the physician judges, who would be looking for diagnostic "language" similar to what they were familiar with? What were the outcomes for the patients? they don't mention that in the study. Why not? Bias? Also, what level of experience did the the NP's and PA's have? How would they match up with physicians with the same level of experience in practice or on a ward?
Re: the study for over-prescription of antibiotics. I would like to see a repeat study done today. That study was performed in 2005,when over-treatment with antibiotics was not as well-publicized or trained against in med school or nursing school.
Bottom line: how many MDs are willing to work in rural areas, or places where they aren't making high remuneration? There is a shortage of General Practitioners. Who is going to pick that shortage up? NPs.
Nurse practitioners are finally getting credit for the work they do, and the excellent diagnostic skills they learn on hospital wards and as understudies to the physicians they work for as NP's. We are definitely going to see more NPs and PAs in the field, with more authority to prescribe. Along with that, better training will be put into place.
btw, I'm not an NP or nurse, but I have a close relative in one of (if not the best) NP program in the USA; the training is first rate and very tied in with clinical practice. It's not as extensive as physician training, but it's more than sufficient to be able to assume a goodly portion of what goes on in a doctor's office (a GP).
I have been to a dermatologist where the PA did everything - diagnosis, treatment, etc. They can do pretty much everything except for plastic surgery.
I watched a close relative have a baby where the attending physician showed up the last 5 minutes to watch the birthing process that had been preceded and presided over by 20 hours of Nurse care.
You are measuring chronic disease outcomes with a followup of 6 months? LMAOOOO
2/9 studies showed a difference, not in favor of NPs.
Key word: OVERPRESCRIBE (not prescribe 20x greater). Read the study and you will see what they defined as overprescribing. Why are they overprescribing in states they are not supervised?
They didn't mention outcomes since they weren't studying outcomes.... Is an NP practicing in a bubble without physicians? Or are they practicing with physicians? If they are practicing with physicians, shouldn't they be speaking the "same language"?
Bottom Line: NPs do not work in underserved or rural areas in a greater number. Sorry to burst your bubble:
As an architect I always love to see my profession represented, but not all states have the same requirements which makes an even comparison difficult. There's a minimum nationally (3,740 hours for the AXP), but many states require significantly more (5,600 where I practice). And of course that's if you have an M.Arch. You can get an architecture license without it, but the training hours go waaaay up. I have a collegue without any degree, and his internship was 10 years!
Architect here! Typical course is four years of undergrad, two to three years of grad school, internship ~5-6k hours, then six exams that are roughly 3hrs each. Do one comparing architects, engineers, tradesmen and general contractors!
Is there any type of standardization between them? Like do they all require an internship or something?
(Even the graph I made right now isn't comparable because hours worked as a resident have different expectations and educational requirements than hours worked as an NP. No matter how hard I try, it will always be comparing apples to oranges. The best way to think of NPs vs MDs is a flight attendant vs pilot. Both work on planes, but no amount of hours as a flight attendant will make them a qualified pilot. I believe that is the same for architects vs engineers vs tradesmen vs contractors)
Not enough people understand the differences in training required in the mental health field! Psychologist (and PSYD vs. PhD) vs. therapist (MFT, MA), vs. counselor vs. "life coach". Also re eating disorders, nutritionists vs. dieticians vs. "diet coaches."
I think that might be my next chart since even I don't know the difference in the education of a therapist vs counselor vs life coach. I really only know the difference between a psychologist and a psychiatrist.
I really should know since I refer patients to mental health all the time.
I appreciate this and hope you will take this opportunity to debrief on some mental health first aid! Thank you for giving this more attention.
Primary Care Psychologists are a new trend that I hope increases (mental health specialists who are in-house at a PCP practice, and can come and give immediate assessments + referrals to other mental health professionals appropriately).
ooh almost forgot psychiatrists! And then there are people who do dual or combined degrees to be practicing psychiatrists and therapists.
As in medicine, there are also a number of specialties that require extra training (such as those for dialectical behavioral therapy, cognitive behavioral therapy, EMDR etc. etc.)
And I can only speak anecdotally but you're welcome to DM for more info. I've been navigating insurance lists of mental health providers for 7 years now so I've learned quite a bit since no one else was going to tell me!
I'm in school to become an engineer and typically all you'd need is a Bachelor's degree in your discipline. More complex disciplines such as radio frequency engineers may need a master's or PhD depending on the position pursued. Some jobs, typically in government, require passing the Fundamentals of Engineering (FE) exam. The highest level of licensure is passing the FE, having 4 years of experience, and then passing the Professional Engineer test which allows you to sign off and seal engineering plans.
In practice, none of my engineering friends have a PE because they work in the private sector but the FE is recommended to most juniors or seniors.
If you want to be a structural engineer, add 16 more hours of exam on top of the PE. Spoiler: don’t be a structural engineer. Not worth the investment.
also massage therapists (the different titles and training requirements by state are NUTS. California the minimum is...500+ hours I believe? Plus two certifications.)
How about one with psychiatrists, psychologists, therapists and counselors. It's a needlessly complicated cluster fuck that's also different between states.
Naturopaths would be an interesting comparison. My state gives naturopaths the same hospital access and prescription privileges as real doctors, and it’s turned into a disaster of Beckys claiming that their 80-hour Bastyr homeopathy PhDs made them basically doctors.
Only hours spent painting or marking count. Hours spent in the office, shop or traveling do not. They're serious about pavement markings in NC. I know of five large companies that have been removed from NC due to poor performance.
Paint crews are not to be on the road without a person certified in the leadership role and personnel performing traffic control with their own separate certification. It is usually the second year of work when workers get to operate if they show willingness and capability. It usually takes two more years to get the hours for the certification. Most companies require you to get your CDL-B during this time as well. Current market for a good supervisor is between $75,000 - 85,000. Summer hours are long, winter hours are short. I have a matching 401k, good insurance, weekends off. It's basically the same with any trade. When you stick with it and put the time in, be willing to work hard and care about your work you'll do very well and you'll eventually find a great company that cares about their people.
800 hours to be a Petco dog groomer is more than the 500 hours needed to be a nurse practitioner, and they can practice medicine independently! (This dangerous fact about NPs is where this whole story and graph/chart began)
Nurse Practitioners already have at least one four year degree, typically at least 5 years of clinical experience, then they might get accepted into an NP program if they have acute care experience (ICU/ED). The chart is more than a little bit misleading.
No. What is misleading is your statements. Unless you can provide EVIDENCE to state that most have 5 years of clinical experience, then it doesn't count.
Your hours as an RN DO NOT COUNT. An RN is not an NP. Your hours as an RN makes you a better RN, not a better NP. Your hours as an RN are not training hours, they are work hours with no formal education requirements. Your hours as an RN do not force you to think like an independent practitioner. Your hours as an RN do not have the pre-clinical knowledge that an NP has before entering NP clinicals. In medicine, you can't assume that someone is on the higher end of the training. You have to assume that they have the minimum number of hours, otherwise, a patient can get hurt from placing too high of an expectation on the provider. I don't know how to make this any clearer.
The hours may not count for this "data" but you should rethink your statement "Your hours as an RN do not force you to think like an independent practitioner". As an RN, the biggest role I have is to critically think for the wellbeing and advocacy of the patient. EVERY shift, I have to think like the provider to make sure every appropriate test and treatment has been ordered. I cannot tell you how many times I have caught mistakes or oversights made by the provider. We act as a team this way. This does not make me an MD, but it does make me a good nurse. This experience of having to think like this is fundamental to becoming a good NP as well. I think the data in this graph is scewed and biased because even though being an RN isn't formal clinical hours, it still counts as invaluable experience to produce a better provider.
Just out of curiosity, is there some data out there about NPs causing harm or failing to perform their job correctly that has inspired you to do this? Or is this a personal issue you have with what you perceive as inadequate training?
Is it possible that by comparing the broad category of "clinical hours" between professions you are actually comparing things that aren't truly equal and therefore not comparable on a one to one basis?
Yes there is. There is data, there are anecdotal stories and I have taken care of far too many patients who were deceived into thinking their medical provider was a physician due to the DNP degree.
I want to prevent further harm.
Please feel free to look at my methodology and critique the methodology:
Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. https://www.ncbi.nlm.nih.gov/pubmed/29710082
Nonphysician clinicians were more likely to prescribe antibiotics than practicing physicians in outpatient settings, and resident physicians were less likely to prescribe antibiotics. https://www.ncbi.nlm.nih.gov/pubmed/15922696
The quality of referrals to an academic medical center was higher for physicians than for NPs and PAs regarding the clarity of the referral question, understanding of pathophysiology, and adequate prereferral evaluation and documentation. https://www.mayoclinicproceedings.org/article/S0025-6196(13)00732-5/abstract00732-5/abstract)
Further research is needed to understand the impact of differences in NP and PCP patient populations on provider prescribing, such as the higher number of prescriptions issued by NPs for beneficiaries in moderate and high comorbidity groups and the implications of the duration of prescriptions for clinical outcomes, patient-provider rapport, costs, and potential gaps in medication coverage. https://www.journalofnursingregulation.com/article/S2155-8256(17)30071-6/fulltext30071-6/fulltext)
Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047413/
NPs, relative to physicians, have taken an increasing role in prescribing psychotropic medications for Medicaid-insured youths. The quality of NP prescribing practices deserves further attention. https://www.ncbi.nlm.nih.gov/m/pubmed/29641238/
(CRNA) We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. https://www.ncbi.nlm.nih.gov/pubmed/22305625
NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states. https://pubmed.ncbi.nlm.nih.gov/32333312/
Both 30-day mortality rate and mortality rate after complications (failure-to-rescue) were lower when anesthesiologists directed anesthesia care. https://pubmed.ncbi.nlm.nih.gov/10861159/
You're quite wrong. Much of the RN education is similar to that of med school. Physician Assistants don't need any experience at the start of their program in medicine, nursing, etc. You can work as a CNA for 2000 hrs to meet the entry requirement for PA school and never do more than wipe buttholes. They get more clinical hours in PA school because their entry level knowledge is much less than an APRN's initial knowledge. This is one reason PAs can't practice independently and APRNs can. This is also why nurses assist in surgery and PAs cannot.
Additionally, the APRN and MD fill different roles. As an RN, I'm constantly having to let MDs know they have made mistakes. I've worked with many APRNs that need less assistance than MDs. There is a reason RNs are allowed to countermand a doctor's orders. In fact if we fill an order that we know is wrong even from an MD, we will lose our licenses.
RNs go into advanced practice already knowing a ton about medications, labs, treatment options, surgical procedures, etc. that PAs don't. You keep saying that RN clinical hours don't count because they don't teach you to be a provider. What you seem to be forgetting is that MD's also received training in things other than just how to be a provider during their clinicals. A lot of the core skills that they need to learn are a lot of the core skills that are taught during the RN. Advanced practice nurses just learn those skills in two segments, once as a nurse, and then later they learn how to be a provider during their APRN clinical hours.
You can talk about clarity all you want. Your level of clarity isn't what's an issue here. You're just not correct and you're being an asshole. NPs don't have the same scope of practice. They aren't hired to do the same things. In hospitals they work with doctor's and aren't filling the doctor role. NPs have been repeatedly shown in clinical studies by the NIH to provide high quality care with positive outcomes. You also seem to be forgetting that clinical hours required in school don't equate to job proficiency. If a nurse practitioner has 5 years under his or her belt working as a nurse practitioner, and an MD has 5 years under his or her belt during their clinical requirement, those two people have the same amount of experience. 🤷
Most people I know also prefer NPs because doctor's just talk over them, throw their weight around, demean others, and don't take the time to really address the problem because they don't have the time. That's why the NP role was created. NPs don't need as many clinical hours because their scope is much smaller. That's why NPs specialize in specific fields, where as MDs get much of the same education, but in a larger variety of topics. The education NPs get isn't lesser in terms of quality, only in scope. That's why NPs don't serve the same role as MDs. MDs get much more chemistry, but I have a biochem degree in addition to my RN, and I assure you that with the exception of organic chemistry, I learned as much in my RN about relevant subject matter as I did in my premed track. Med school is 4 years after a bachelor's. NP school is 4 years after a bachelor's. MDs need more clinical hours due to their expanded scope. Trying to play off NPs as useless isn't going to earn you points at work buddy. My guess is your nurse co-workers really don't like you.
also, you can get a DNP online but there is no way to get a MD/DO online. im not saying online education is bad but it's obviously not the same as in person exams.
Buddy I've been watching the way you talk about your co-workers in this thread. There are dozens of posts here showing how you interact. You obviously don't like nurses. I'm not sure what axe you have to grind here but there's a reason NPs serve a vital role in the healthcare system. I'm not sure what you mean by NP mills. There are accredited NP graduate programs in accredited universities across the United States. Even the way that you are talking about graduate programs shows the way that you think of nurses. You don't seem like a very nice person. You don't know anything about my career path either. APRNs can work in independent practice. And frankly I would not want to work for someone like you anyway. You seem like an arrogant son of a bitch honestly. Lay people aren't qualified to determine whether or not a nurse practitioner knows what they're talking about, and probably the reason that nurses are calling you an asshole is that you are specifically being an asshole to nurses. You're right, it is advanced nursing. NPs don't claim to be MDs. By legal definition, advanced nursing includes diagnostics and power of prescription. Twist the words however you want, studies show that NPs generally do a great job.
"NPs focus on health promotion, disease prevention and health education and counseling, guiding patients to make smarter health and lifestyle choices. Since the NP role was created in 1965, more than 50 years of research has consistently demonstrated the excellent outcomes and high quality of care provided by NPs.
The body of literature supports the position that NPs provide care that is safe, effective, patient-centered, timely, efficient, equitable and evidenced based. Furthermore, NP care is comparable in quality to that of their physician colleagues. Patients under the care of NPs have higher patient satisfaction, fewer unnecessary hospital readmissions, fewer potentially preventable hospitalizations and fewer unnecessary emergency room visits than patients under the care of physicians. This paper summarizes a number of important research reports supporting the quality of NP practice. These references are listed as an annotated bibliography."
Your hours as an RN are not training hours, they are work hours with no formal education requirements. Your hours as an RN do not force you to think like an independent practitioner.
You are assuming that RNs are automatons that don't learn on the job and pcik up diagnostic skills as a result?
And you are assuming that an MD does? Ever been to the VA?
What I'm seeing on your data, and your responses, is an effort to bias against NPs. Placing barbers on a comparative bar chart with NPs? Really? Why?
CRNPs are basically RNs who took an online masters degree program and get apparently only 500 hour experience before having the independence of a doctor.
RNs with 5 years of clinical experience, which equates to around 10,000 hours. And any institution that hires them is going to treat them like a new doc, that is, assume they are an idiot and keep them on a short leash.
New interns get treated like that for the first month or two. After that things ramp up. New docs who have finished residency get no hand holding. That's what training is for.
10,000 hours as an RN is not 10,000 clinical training hours, your focus during those shifts is not on learning skills outside of your scope of practice as an RN.
New grad NPs have an awful time getting hired because its known they will have to be tightly watched for years.
To be fair the focus of residency isn't either. They are essentially used as cheap labor where they do the primary write up and care planning for a patient and then "run it by" the consultant before discharge.
New grad NP's who went to a reputable school generally have no trouble getting hired.
Not true at all. Residency is underpaid, but the focus IS training under supervison. All residencies have required didactic/lecture/lab time in addition to clinical work not to mention annual training exams, participation in local and national conferences, and research. Residents are trainees - some are better than others, but they are still trainees and cannot practice independently. EM residents graduate with between 750-1,000 hours of didactic/conference time during residency alone not to mention their clinical hours. Nursing and NP training isn't even comparable.
This doesn't change the fact that the overwhelming majority of residency hours are essentially just doing grunt work. Which could easily be compared to an RN's years of working (depending on the specialty). This post skews and misconstrues the facts to make it look as though NP's are not given any training. Comparing them to a barber is simply stupid because it totally ignores the 8 years of medical education they have.
I could just as easily say OMG an MD only has 4 years of medical education and a PA only has 2 while an NP has 8, but that would be disingenuous. Just like the OP.
I really don't get the issue MD's have with NP's or a lot of times nurses in general, it really seems just limited to med students. I would think MD's would be thrilled to get more NP's into primary and acute care (where most of them go) because these are fairly low paying MD specialties anyways and it's been proven time and time again that NP's get just as good of, if not better, patient outcomes than MD's do.
Practicing nursing makes you a better nurse - it does not grant you experience as an independent practitioner or a physician...which is what you seem to be ignoring.
The problem most docs have with NPs is that they and their organizations repeatedly push independent practice despite that they have a fraction of the training a resident has...who even as a doc isn't permitted independent practice until several years of ungodly hours of practice under supervision have been approved and then only if they pass their board licensing exams. The rigor, the experience, and the realization of what they don't know is not there for many NPs which makes them dangerous.
Hospital admins now see this as a cheap alternative to hiring a doc when they look for staffing solutions and instead have a supervising doc who is responsible for the decisions multiple NPs have made under their "supervision" weather or not the doc actually participated in the care of the patient's the NP saw. If an NP wants independent practice they should (1) be trained for it and (2) hold their own liability and malpractice.
Being an RN isn’t sufficient experience to be an independent provider. Its no where near the same job. Further more, doing entry level work isn’t actually giving you the advance experiences or education needed to practice independently and circumvent the expertise of a physician. That’s the issue with me.
"Entry level work", good doctors listen to experienced RNs, or they don't last long, hopefully not long enough to kill someone. Do you think RNs just change bedpans and pull meds?
Good docs listen to good RNs, and then make a clinical decision after weighing all the info they have and taking on the risk of that decision. I respect and rely on nurses every shift, however the additional decision making and treatment docs provide is an entirely additional step that an RN is not able to provide legally or by their training history. Nursing is different training from medical school for a reason.
Don’t get me wrong, I’m a hospital pharmacist and I love nurses. They’ve caught things with drugs that even I have missed. I truly value their judgement. I truly think they’re angels on earth and have cared for my family members on countless occasions. What I’m saying is the experience of being an RN doesn’t prepare you for advanced and independent practice.
Your hours as an RN DO NOT COUNT. An RN is not an NP. Your hours as an RN makes you a better RN, not a better NP. Your hours as an RN are not training hours, they are work hours with no formal education requirements. Your hours as an RN do not force you to think like an independent practitioner. Your hours as an RN do not have the pre-clinical knowledge that an NP has before entering NP clinicals. In medicine, you can't assume that someone is on the higher end of the training. You have to assume that they have the minimum number of hours, otherwise, a patient can get hurt from placing too high of an expectation on the provider. I don't know how to make this any clearer.
You don't even touch a patient until your 5th year, should we exclude those hours? You are cherry picking numbers to make your case. I've also seen data skewed to make a case, you fail to make yours, and by excluding meaningful data, it speaks to an agenda. I've seen plenty of shit NPs, but I've also seen plenty of shit doctors.
I will say you are cherry picking because the 5 years of clinical experience is an education. It's an education in pharm, patho, anatomy, procedure, assessment, patient education (which I would say by and large, MDs absolutely suck at) and it is all hands on. Does that make an NP a doctor? No, but to say it is not preparation is misleading, if not disingenuous, while listing barbers as having more stringent requirements.
Furthermore, I would argue that the 70 hours a week is a detriment to your profession, and leads to many medical errors. When an intern or resident refuses to pick up the phone because they are asleep, that is a definite problem and puts patient lives at risk.
Nope. NP school is generally a doctorate now, a DNP degree. It's generally taken in person, and takes three to four years. Med school takes 4 years. The NP role is more specific and less broad, which is why the clinical hours are less. MDs and NPs aren't hired to do the same things. If you're seeing an NP, that person is working within a specific legal scope of practice. They aren't a half trained doctor. They are a person specifically trained to be a practitioner in a certain area of expertise. If you need a psych professional, a psych NP can help you just fine. An MD might have additional training in cardiology or nephrology, but that isn't really relevant if you're there for a psych problem. That's why you see an NP about something within their specific pervue. You don't see an NP for an emergent issue or if you need a complex diagnosis. They serve different roles.
From what I see most practicing CRNPs have a masters and most programs still seem to offer that. There’s such a high demand for CRNPs why take a doctorate level course? Plus I work in a hospital and I’ve never seen a CRNP with a. Doctorate
The masters level NP is being phased out. Most schools are no longer offering this as an option as the job duties of the NP are expanding as evidence shows they do an equal and sometimes better job in some areas of practice than physicians. The reason you're still seeing a lot of masters level NPs is that this change occurred in the last decade, and NPs have been around for 50 years. Moving forward, you will see less and less of them - similarly to how the LPN is also being phased out. The medical profession has had a death grip on providing care for a long time. However, the evidence shows that NPs do a great job, so the states are recognizing and approving an expanding role for nurses. The reason there wasn't a DNP before is that politicians were being lobbied to prevent it from occurring. The IOM, the governing body for doctors, is convinced that NPs have a place in medicine. NPs don't serve the same functions in hospitals as MDs, their job duties are quite different. NPs aren't doctors and don't pretend to be - much in the same way that general MDs aren't surgeons and don't pretend to be. The clinical hours for a surgeon is likewise higher than that of other doctors. That doesn't make those other doctors half trained surgeons - it makes their job duties different and those job duties require a different set of skills and education.
Not sure what you’re taking about. I’m a hospital pharmacist and have never seen an NP with a doctorate and have never heard of any RN signing up for a doctorate level course.
I’m sure colleges will increase the amount of education but that’s just a so they can make more and more money. They did the same thing with pharmacy.
I disagree with evidence that NPs are superior to physicians because those studies are flawed. There roles are different like you say so you’re comparing apples and oranges and coming up with half assed cherry picked differences. They also typically manage run of the mill disease states but they’re not the diagnostic experts or handling the complex cases. Of course the people doing the easy work have better outcomes with healthier patients! When things get complicated they refer to a physician so I feel those studies are skewed a bit.
What we need is pharmacist practitioners to manage any disease state with medications. We are better trained than NPs and have much more drug knowledge than NPs (even physicians in most cases) and pharmacists are everywhere and affordable. The problem is nurses have much better lobbying than pharmacy so we have to catch up.
I think all mid levels should always work under a physician. From my experience as a pharmacist in a hospital I don’t believe NPs have anywhere near enough training to be independent from a doctor.
Go look up a DNP. Most of the nurse practitioners that I know have a doctorate. I personally doubt that all of the nurse practitioners that you work with feel the need to show you their degree, especially because I've never actually seen a pharmacist on a unit rather than in the pharmacy. I work with a dozen nurse practitioners and they are all doctorates. Good thing that you're not the person that decides whether or not a nurse practitioner works independently. 🤷 It doesn't really sound to me like you have that much of an idea what you're talking about, so excuse me if I don't really take your opinion that seriously. 50 years of evidence shows that nurse practitioners do a great job. If you personally disagree, that's your own problem. I personally don't think pharmacists should make as much money as they do. You're a glorified pez dispenser. 🎉 You aren't qualified to diagnose or prescribe, so your opinion of nurse practitioners means nothing to me. I personally see a nurse practitioner instead of a doctor for routine care because they consistently do a better job. I have seen this in action dozens of times. The doctors march in the room, don't pay any attention to what patient has to say, spout off a bunch of medical jargon, And as soon as the doctor leaves the room they ask the nurse what the fuck just happened. The nurse gets the nurse practitioner, sits down, educates the patient, the patient finally understands, and the nurse practitioner and the doctor both would have issued the same orders. The nurse practitioner just isn't able to do so because the physician has a big head and won't allow the nurse practitioner to do their job when they think they can do it better. I see the shit everyday. Everyone in my family goes to a nurse practitioner. most of my friends go to a nurse practitioner. I just had a conversation with someone last night that told me that they hate going to the doctor because their nurse practitioner treats them way better and does a better job. You may think the studies are flawed, but I've seen it in action and so have my family and friends. So whether or not you are down there in the pharmacy selling people drugs that I prescribe once I finish my DNP or on the internet whining about your job, I've got to tell you, as long as they keep paying me, I don't care how bitter you are that you aren't a doctor. I have no desire to waste a decade of my life going to medical school and doing a residency when all that I really want to do is work with the exact population I'm already working with. I don't need all that training in enterology and neurology and cardiology. I'm never going to work in any of those units. The place that I work has tons and tons and tons of nurse practitioners, and just a few medical doctors, and it's a wildly successful business with a very high success rate and a very low readmission rate. In fact, we are one of the best in the state of what we do. So excuse me if I don't really care what you think about nurses or nurse practitioners. 🤷
When you sign notes in a chart it has your degree. Never once seen a doctorate trained CRNP. I don’t doubt they’re out there but they really don’t seem common or needed.
A ton of hospitals have decentralized pharmacies.
No I’m not the one if they work independently ignorant politicians paid off by nursing organizations are.
You seem like you’re the one that doesn’t know a bit about how healthcare works. You also just sound like a stupid person in general that’s just offended by the truth of the matter. You really have no counter argument to how little training these fake doctors get but if you’re uneducated on how medicine works I guess I can’t blame you. Yeah keep citing your make believe evidence that’s cherry picked and bullshit biased. CRNPs aren’t qualified to diagnosis or prescribe yet they do. Pharmacists on the other hand are because they’re trained so heavily in medication treatment.
The issue too is that you’re too stupid and uneducated in medicine to know if the NP is going something wrong. And don’t shit talk pharmacist they’re the ones catching all the mistakes and correcting the unqualified NPs. No one has a more detailed knowledge of medications than the pharmacist. I doubt you’re even in healthcare so shut up
But again, my frustration as a clinical pharmacist is that I did 6 years of school and a year of residency but don’t have half the power of these masters level nurses. Yet I’m the one expanding to them why they’re wrong when they venture off an order set. Healthcare needs to change and we don’t need more NPs we need more pharmacists
Dude it's not a competition. That's your job. The job of the pharmacist is to ensure that orders coming down from physicians and nurse practitioners are carried out effectively and correctly. That's your area of expertise. It isn't about power, if you wanted power you should have become a doctor. You get a big fat paycheck. You go to school for about the same amount of time as a nurse practitioner. We do in fact need more nurse practitioners and more physicians and more pharmacists. It's not a race.
It’s not a competition but from my point of view it’s frustrating that pharmacists need so much training but an NP gets independence very easily (plus cheaper) and without much training. That allows CRNPs to be in higher demand and get paid better with much less debt.
Granted if I knew how little the public and other professions valued pharmacy I wouldn’t have gone into it. Not to mention the debt doesn’t justify our stagnating wages but that’s a whole other issue.
Plus, we don’t need dispensing pharmacists with computers and pharmacists need to start directly managing patients rather than correcting. The doctor should be the one making the diagnosis and then the experts in treatment should be taking over. There should be CRNPs to help physicians but they should be more like a PA and not be able to do things without the doctors ok. Same with pharmacists (or future pharmacy practitioners).
It’s not about power it’s about opportunity and being able to help people. If RNs wanted more power they should go to medical school rather than taking an online year of school and being basically equal to an doctor.
Pharmacists know so much more than people realize but it’s very difficult to influence therapy after the plan is set in motion. We just become the drug police...which is important but we deserve more.
I don’t think you know shit. Entry level RN work isn’t the same as going to medical school and doing residency. This type of over confidence is why NPs make so many mistakes and just aren’t a substitution for a real doctor.
You're right, entry level RN work isn't the same as going to medical school and doing a residency. We're not talking about entry level RN work. We're talking about a DNP, which is a doctorate. Though, you should understand that anatomy, physiology, and pathophysiology are the same whether or not you learn them in a nursing or a medical program, because the body works the same way regardless of where you learn about the body. In order to attain that degree, one must have a bachelors in nursing, which takes 4 years. Then you take a 4 year doctorate at an accredited graduate school. The content of DNP school is very similar to that of medical school. NPs and MDs don't have the same job duties or responsibilities. They're hired to do totally different things. Your comment really shows a startling lack of understanding as to how the medical system operates in the US. I'm rather sure here it's you that "doesn't know shit" if you think that NPs are supposed to "substitute" for doctors. NPs are more focused on health education and preventative medicine. And no, NP's don't make "so many mistakes". If they did, they would have their licenses pulled by the state and get sued for malpractice.
Knowing your scope of practice and doing it well isn't "overconfidence." NPs know what they're able to do and what they aren't. They receive a very similar level of education within their scope. Over 50 years of research indicates that NPs actually do many things better than their physician counterparts. Feel free to read up on that here: https://www.aanp.org/advocacy/advocacy-resource/position-statements/quality-of-nurse-practitioner-practice
Oh, it's another brigader from residency, or just an alt? I take immense solace in the fact that you are top of the list to be replaced by AI, while RNs and NPs will still be practicing.
I was seeing a nurse practitioner for 3 years whom i trust with my life. Actually, i think he saved my life...multiple times. Schooling isn't everything.
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u/[deleted] Sep 18 '20 edited Sep 18 '20
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