<p>well, things have changed since I was in school. Physician involvement has to be looked at in 2 different ways.
There are prescribing rights and then there is involvement in diagnosing. 2 very different things.
Most of the states that NP have full rights in prescribing and diagnosing seem to be in areas that there are very low numbers of MD’s per capita.
[Total</a> Nonfederal Physicians (per capita) by state](<a href=“http://www.statemaster.com/graph/hea_tot_non_phy_percap-total-nonfederal-physicians-per-capita]Total”>http://www.statemaster.com/graph/hea_tot_non_phy_percap-total-nonfederal-physicians-per-capita)</p>
<p>^ yes, but there is also a huge difference between prescription/diagnosing rights (which PA’s can do), and having a practice completely independent of physician oversight. PAs (even in those remote areas without physicians) are required at a minimum to have a physician medical director of their practice that does some form of QI like consultation and chart review, as well as setting certain policies. The NPs want medical practice completely independent of physicians.</p>
<p>Icarus, I agree with you. I do not favor an NP not to have any physician involvement. I think a collaborative relationship with a physcian is in the best interest of the patient. However I do not think the physician needs to be present and directly overseeing everything on to moment to moment basis. I do not like the fact that some NP’s get into things way over their heads with problems, thinking they can handle it, then punt it to the MD after the fact when it is sometimes too late.</p>
<p>Hard to know where to begin. Nurse practitioners are nurses with advanced education, masters and doctoral level, and are prepared to provide care across the health-illness continuum. We are not MDs but practice independently, as state regulation allows, in overlapping and sometimes very similar practice environments. I have been an NP for over 30 years. Became a nurse in a great BSN program, worked with underserved populations in public health, worked in critical/cardiac care, rural -isolated acute care and then became an NP. Those thousands of hours of experience laid the foundation for my NP education - and I was quite young at the time. Since then, my experiences and further education have all deepened and enriched my professional competence. I practice and teach in a state that has granted NPs independent practice without the requirement for supervision and collaboration with very broad independent prescribing rights. I use those privileges judicially and with great humility to the benefit of the patients I serve. Although many of us work as members of a team, when I make a clinical decision about diagnosis, treatment, etc. I am fully accountable for my actions. I continue to work with underserved populations that many MD/DO practices will not see and manage the full range of undifferentiated complaints and symptoms, using all the resources at my disposal. After my decades of practice, I have less as well as more experienced MD/ DO seek my advice and counsel about patient care. I certainly reciprocate when I need a consultation. Just because medicine has one path to becoming a competent care provider does not negate other ways/ paths to becoming a competent, allopathic, evidence-based,knowledgeable, and independent clinician. There is no evidence that the American model of medical education is best suited to meeting the challenges of the chronic illness crisis our population faces or that it is the best preparation for primary care. Other models of medical education in Britain, Netherlands, Norway, Australia offer a very different, more primary care focused six year education from end of high school to practice. So, not all MD/DO are cut from the same cloth. As for nursing as a career, apart from the fact that I make a modest income after decades, I can’t imagine a more enriching and rewarding journey. I have been so honored to share some of the most intimate moments of others lives. They and their families have taught me so much and I am truly thankful for that gift. MD/ DOs and NPs are different clinicians, both provide high quality care, both are needed in the health care system. All the comparative studies of NP and MD care demonstrate equivalency or better performance for NPs providing primary care and chronic illness care. Remember, NPs have historically worked with complex patient populations in underserved areas because MD/DO were not there to provide care. Look at the history of Mary Breckinridge at the Frontier Nursing Service and more recently, Mary Mundinger’s randomized control trial of NP and MD primary care in NYC. And, there is good evidence that the more BS nurses on staff in hospitals, the better the outcomes for patients. We need a mix of providers but better educated nurses have proven benefits. The health care system would be best served by removing barriers to practice and allow all health care providers to practice to the full extent of their knowledge and skills with oversight by their professional regulatory boards, not by another discipline. See <a href=“https://www.ncsbn.org/ScopeofPractice.pdf[/url]”>https://www.ncsbn.org/ScopeofPractice.pdf</a>, a document developed jointly by the Federation of State Medical Boards (FSMB) and other health boards concurring the the development in one discipline - expanding scope of practice, should not be constrained by another discipline’s historic dominance in the area. The primary concern should be the public safety and the public benefit. Over thirty years of evidence demonstrates the safety and value of nurse practitioner care.</p>
<p>momgeh50,
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<p>Wow, that a blast from the past, she was my college professor in the 70’s.</p>
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<p>And I agree - like I said, this is how it is done for many PAs in rural areas. The physician is not on site, but rather oversees by way of chart review and phone consult when necessary.</p>
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<p>This is where we agree, momgeh50 - but I simply do not think that the NP curriculum and knowledge level is sufficient for independent practice, especially when it is inferior even to another profession that does not allow for independent practice (physician assistants).</p>
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<p>And I agree here as well. However, what you are practicing is medicine, not nursing. We could play with semantics all day, but when you examine patients, legally make a diagnosis and treat the disease, you are practicing medicine, period. Like I said in a previous post, PA’s recognize that they are a part of the practice of medicine. By and large, PAs are regulated by their respective state’s Board of Medicine, not a separate Board of Physician Assistants…</p>
<p>The NP’s where I work are under the MD’s supervision. They are the adjunct, because the units/acuity are too much for for the medical staff. It has worked out quite well. The Northeastern sudents are the ones I was talking about. I will ask them their opinion this week.</p>
<p>I strongly disagree that NP education is inferior to PA education. The foundations for NP education and PA education are different and distinct. PAs have continued their historical connection to medicine and at this time continue to have their practice authority be promulgated by boards of medicine and are to be supervised (I think in most states?) by physicians. Who knows what this will look like in 20 years. NP education provides for advanced practice nursing, which in number of states is wholly under the oversight of the Board of Nursing and does include diagnosis and treatment including pharmacotherapeutics. When I diagnose a stress fracture or herpes zoster, or attend the narrative of grief described by a woman who has recently lost her husband, I am practicing nursing and am regulated as such. I am fully accountable for my actions under my nurse practitioner license. I do not practice medicine but I use medical knowledge (and nursing, physical therapy, pharmacology, psychology, dental knowledge, etc…) and must be accountable for standards of health care practice in the communities in which I work. Knowledge is not owned by any one discipline. The nature of knowledge availability, opportunities for skill acquisition and competency evaluation has transformed the identities of all professions. We now have bright lights shining on the guild traditions that created market control and protected practice. In our state, NP students are fully aware of the independent nature of the advanced nursing practice to which they are aspiring and take this learning and practice responsibility very seriously. NP education builds on professional nursing education and practice and includes the development the knowledge, skills and attitudes required to provide safe, patient/family centered care, life-long learning, and reflective practice. Nurse practitioners are committed to working collaboratively with all health care providers to provide optimal care to the public we all serve. PAs, MDs, DOs, as well, have their unique and overlapping contributions to make to the health care system.</p>
<p>Mary Mundinger gave me my only F in grad school.</p>
<p>momgeh50,
Thankyou for your calm, well communicated insight on the NP practice and autonomy. Unfortunately, medicine is threatened and confused by the growth of nursing in healthcare. I am glad that many successful pioneers like yourself, still have enough energy to explain their role and scope of practice. Mary Mudinger was also a graduate school professor of mine. You are so right, knowledge is not owned by any one practice. I hope that all paths can continue to work well together in the mutual goal of quality patient care.</p>
<p>I find that there are many physicians that are threatened by NPs.Among my peers, we call them the 70’s doctors. Just can’t wrap their heads around it.</p>
<p>I polled the new grads at work, while they do not have 100 k in debt some have around 40K. Entry level at my hospital is BSN currently. Northeastern grads definately have the edge getting into hospitals (coop) but NE is very expensive as well. Most agree that in other parts of the country it is different.</p>
<p>What is the rep of other nursing schools in Boston? UMass, Simmons, BC?</p>
<p>Interesting article on nursing:</p>
<p>[Nursing:</a> The Opportunity To Make A Difference : Health and Medicine : Careers And Colleges .com](<a href=“http://www.careersandcolleges.com/tp2/cnc/articles/view.do?cat=cnc.si.health-and-medicine&article=nursing-the-opportunity-to-make-a-difference&r=apr09hs2]Nursing:”>http://www.careersandcolleges.com/tp2/cnc/articles/view.do?cat=cnc.si.health-and-medicine&article=nursing-the-opportunity-to-make-a-difference&r=apr09hs2)</p>
<p>They are all considered excellent.</p>
<p>Thanks. Just wondering if there were any advantages in attending one school over the other, with respect to the reputations of the schools. Some programs have a higher board pass rate as well. Surely that would be a measure of the effectiveness of the teaching?</p>
<p>Earlier in the thread, someone mentioned Yale nursing as a reputable program. I just wanted to point out that Yale has no undergrad nursing program–only graduate level.</p>
<p>^ I have the same questions. </p>
<p>Also, does anyone know if there is a correlation between the quality (or ranking) of an undergraduate program to the graduate program at the same college or university? It looks like US news has developed a “ranking” for graduate nursing programs. The only “ranking” I could find regarding the quality of undergraduate programs relates to research funding.</p>
<p>(I would think that board pass rate and employment opportunities post graduation would be good measures of the quality.)</p>
<p>What about Hunter Bellevue School of Nursing? Is it well-regarded?</p>
<p>^Actually it is very well regarded. I would not ever recommend going to an expensive private school for nursing, it is not worth the money unless you got an absolutely great financial aid package. There are very good programs in state schools. Employers hire nurses at the same level regardless where you go. Also most hospitals require entry level nurses to go through a preceptorship program to transtion from school to actual practice for several weeks or months. As you advance in your career, it is your experience and where you worked that matters, as well as any advanced certifications you have obtained.</p>
<p>It won’t matter, except sometimes very locally. The two hospitals in our town have donated about $750,000 each to the local community college (nothing to any of the BSN schools, the BSN program at our local private university closed) with an understanding that they will get priority in rotations, and be able to recruit among those graduating.</p>