Nurse practitioner training has changed

[Anonymous]

Anonymous wrote:Dear OP, I think advocating that nurses has 2+ years of bedside experience in the area of the proposed NP specialty (or interchangeably ICU or ER), and continue working bedside while studying, are solid.

We do need to get away from the idea that an MD is needed to do basic primary care, gyn care, or low risk specialty care. It is total overkill. While folks doing it around the world are called "doctors", their training is completely compatible with the NP training in the States.

With respect,
"old-style" nurse-practitioner

This is the arrogance which, along with corporate greed, has in less than a generation reduced the quality of medical care in parts of the U.S. to below developing nation levels.

[Anonymous]

Dramatic much? NPs are doing a lot of the primary care in areas that MDs do not want to go. What is your solution for that?

[Anonymous]

Anonymous wrote:Corporate medical America wants to cut costs and NPs and PAs cost way less to pay than MDs. The business of healthcare is brutalizing patients and healthcare workers alike.

This is not the fault of the NPs. Most all professionals want higher pay and more education and programs are more accessible now. Nurses and PAs know their limits. I go to NPs for annual screenings, to get a minor injury treated, etc. and MDs for anything else.

I work in a very well known academic medical institution. Many of the most critical patients are managed by NPs/PAs, with a responsible MD as part of a team. This shared co-visit model is excellent at capturing costs savings while preserving safety of MD level medical decision making and responsibility.

Signed,
+20 year veteran of nursing (and an FNP)

The bolded is the most sane and informed comment on this thread.

The increased use of NPs is the symptom of the larger problem. Tackle the problem.

[Anonymous]

I don't see how this is an issue. They are doing three years of school. Medical school is only two years and a residency. I have a really good NP, I have also had really bad ones as well as horrific doctors. I really don't have any doctors I'd consider great. Training is just part of it.

[Anonymous]

Anonymous wrote:I don't see how this is an issue. They are doing three years of school. Medical school is only two years and a residency. I have a really good NP, I have also had really bad ones as well as horrific doctors. I really don't have any doctors I'd consider great. Training is just part of it.

Uh, med school is 4 years, plus college of course, and a residency could be up to 5 years for done specialties, most prob 2-3.

[Anonymous]

Anonymous wrote:I had chicken pox in my 40s…NP thought it was a skin issue…Brother in law is a pen….diagnosed it in 5 minutes

Similar story here - my shingles was misdiagnosed as cellulitis by a PA at an Urgent Care. I was in agony for several days, as a pregnant woman, until a dermatologist diagnosed me correctly in about 30 seconds. I’m still so grateful to her!!!!

[Anonymous]

Nurse Practitioner here. Chicken pox in a 40 year old is an absolute zebra. Would not be expected. I have been a nurse since 1989 and have never seen chicken pox- either as a bedside nurse or as an NP. As for shingles- when I worked in Internal Medicine, I diagnosed shingles 5-10ish times. In that job, when either my MD boss or I thought someone might have shingles, we would ask the other person to look at it. Shingles, especially at the outset can be tricky. In my current job, in a specialty, I have been asked by MDs to look at 2 patients, a fellow NP once and diagnosed one case. The good news? The treatment (valacyclovir) is pretty benign even if it is not shingles, so treatment starts quickly.

I know these episodes were frustrating and likely painful, but skin conditions are challenging and with chickenpox, so very rare now and shingles, again, at least at the outset, tricky.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I had chicken pox in my 40s…NP thought it was a skin issue…Brother in law is a pen….diagnosed it in 5 minutes

Similar story here - my shingles was misdiagnosed as cellulitis by a PA at an Urgent Care. I was in agony for several days, as a pregnant woman, until a dermatologist diagnosed me correctly in about 30 seconds. I’m still so grateful to her!!!!

Actually your Obgyn should have seen that one and diagnosed easily. While shingles is relatively rare in young women, they are relatively common in the pregnant population due to immune suppression in pregnancy. I diagnose them several times per year.

I can absolutely see how an urgent care provider could misdiagnose, especially at early stages, regardless of training.

“Old-style” NP who commented earlier.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Dear OP, I think advocating that nurses has 2+ years of bedside experience in the area of the proposed NP specialty (or interchangeably ICU or ER), and continue working bedside while studying, are solid.

We do need to get away from the idea that an MD is needed to do basic primary care, gyn care, or low risk specialty care. It is total overkill. While folks doing it around the world are called "doctors", their training is completely compatible with the NP training in the States.

With respect,
"old-style" nurse-practitioner

This is the arrogance which, along with corporate greed, has in less than a generation reduced the quality of medical care in parts of the U.S. to below developing nation levels.

Sadly, third world on average has better health outcomes than USA for many primary care issues. Specifically, our pregnancy outcomes are nearly as bad as Afghanistan. The absolute majority of pregnancies in the USA are managed by Obgyns.

“Old-style” NP

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Dear OP, I think advocating that nurses has 2+ years of bedside experience in the area of the proposed NP specialty (or interchangeably ICU or ER), and continue working bedside while studying, are solid.

We do need to get away from the idea that an MD is needed to do basic primary care, gyn care, or low risk specialty care. It is total overkill. While folks doing it around the world are called "doctors", their training is completely compatible with the NP training in the States.

With respect,
"old-style" nurse-practitioner

This is the arrogance which, along with corporate greed, has in less than a generation reduced the quality of medical care in parts of the U.S. to below developing nation levels.

Sadly, third world on average has better health outcomes than USA for many primary care issues. Specifically, our pregnancy outcomes are nearly as bad as Afghanistan. The absolute majority of pregnancies in the USA are managed by Obgyns.

“Old-style” NP

I’d suggest that if you think any health care statistic from Afghanistan is anything but a fantasy you should probably think some more.

[Anonymous]

Anonymous wrote:I don't see how this is an issue. They are doing three years of school. Medical school is only two years and a residency. I have a really good NP, I have also had really bad ones as well as horrific doctors. I really don't have any doctors I'd consider great. Training is just part of it.

I'm a nurse. The issue is not NPs--it's the education most of them are getting nowadays. It used to be that NP schools would want nurses with experience and most NP schools were part of actual, decent schools. Tons of green nurses now are getting their education from online diploma mills. In the article, a former employee of a diploma mill sounded the alarms that a) the school was basically taking anyone with a pulse and b) the clinical hours for the program left much to be desired. That is not good for patients nor is it good long-term for the reputation of the nursing profession.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Dear OP, I think advocating that nurses has 2+ years of bedside experience in the area of the proposed NP specialty (or interchangeably ICU or ER), and continue working bedside while studying, are solid.

We do need to get away from the idea that an MD is needed to do basic primary care, gyn care, or low risk specialty care. It is total overkill. While folks doing it around the world are called "doctors", their training is completely compatible with the NP training in the States.

With respect,
"old-style" nurse-practitioner

This is the arrogance which, along with corporate greed, has in less than a generation reduced the quality of medical care in parts of the U.S. to below developing nation levels.

Sadly, third world on average has better health outcomes than USA for many primary care issues. Specifically, our pregnancy outcomes are nearly as bad as Afghanistan. The absolute majority of pregnancies in the USA are managed by Obgyns.

“Old-style” NP

I’d suggest that if you think any health care statistic from Afghanistan is anything but a fantasy you should probably think some more.

Possibly, but they are much worse than Europe or Canada, without question. Those places keep decent records. "old-style" NP

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Dear OP, I think advocating that nurses has 2+ years of bedside experience in the area of the proposed NP specialty (or interchangeably ICU or ER), and continue working bedside while studying, are solid.

We do need to get away from the idea that an MD is needed to do basic primary care, gyn care, or low risk specialty care. It is total overkill. While folks doing it around the world are called "doctors", their training is completely compatible with the NP training in the States.

With respect,
"old-style" nurse-practitioner

This is the arrogance which, along with corporate greed, has in less than a generation reduced the quality of medical care in parts of the U.S. to below developing nation levels.

Sadly, third world on average has better health outcomes than USA for many primary care issues. Specifically, our pregnancy outcomes are nearly as bad as Afghanistan. The absolute majority of pregnancies in the USA are managed by Obgyns.

“Old-style” NP

I’d suggest that if you think any health care statistic from Afghanistan is anything but a fantasy you should probably think some more.

(sorry let me clarify - our statistics are much worse than Europe and Canada, places that keep decent records.

Canada specifically also shares many of our lifestyle creep problems.

Some things in medicine are readily solved with better training. But in truth, may primary care issues require time, listening, untangling pt's story, collecting family history, doing simple things first, and knowing when to refer out.)

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I had chicken pox in my 40s…NP thought it was a skin issue…Brother in law is a pen….diagnosed it in 5 minutes

Similar story here - my shingles was misdiagnosed as cellulitis by a PA at an Urgent Care. I was in agony for several days, as a pregnant woman, until a dermatologist diagnosed me correctly in about 30 seconds. I’m still so grateful to her!!!!

Actually your Obgyn should have seen that one and diagnosed easily. While shingles is relatively rare in young women, they are relatively common in the pregnant population due to immune suppression in pregnancy. I diagnose them several times per year.

I can absolutely see how an urgent care provider could misdiagnose, especially at early stages, regardless of training.

“Old-style” NP who commented earlier.

I’m glad to know that shingles is difficult to diagnose. I’m the formerly pregnant lady who posted above. I was 39. I started feeling the pain on a Friday (on top of my head), so it would have been difficult to get an outpatient appt anywhere. The weekend was agony - I took Codeine only when I could not stop swearing from the pain. The truly ridiculous thing is that Urgent Care PA called me the next week to follow-up. He was in disbelief that his antibiotics did nothing and his diagnosis was incorrect!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I had chicken pox in my 40s…NP thought it was a skin issue…Brother in law is a pen….diagnosed it in 5 minutes

Similar story here - my shingles was misdiagnosed as cellulitis by a PA at an Urgent Care. I was in agony for several days, as a pregnant woman, until a dermatologist diagnosed me correctly in about 30 seconds. I’m still so grateful to her!!!!

Actually your Obgyn should have seen that one and diagnosed easily. While shingles is relatively rare in young women, they are relatively common in the pregnant population due to immune suppression in pregnancy. I diagnose them several times per year.

I can absolutely see how an urgent care provider could misdiagnose, especially at early stages, regardless of training.

“Old-style” NP who commented earlier.

I’m glad to know that shingles is difficult to diagnose. I’m the formerly pregnant lady who posted above. I was 39. I started feeling the pain on a Friday (on top of my head), so it would have been difficult to get an outpatient appt anywhere. The weekend was agony - I took Codeine only when I could not stop swearing from the pain. The truly ridiculous thing is that Urgent Care PA called me the next week to follow-up. He was in disbelief that his antibiotics did nothing and his diagnosis was incorrect!

Umm shingles is not hard to diagnose. Same thing happened to me before I went to med school. I was in my 20s and super stressed about applying to med school and an NP I saw at urgent care was literally googling rashes in front of me. A doctor I saw it in 5 secs and diagnosed it. In med school I saw a ton of shingles and also as a resident. We also get tested on it a lot.