As I get ready to go back to school and enter into a Nurse Practitioner program next month, I'm curious to hear (if people are willing to share) what experiences people here have had with NP's and in what situations (if any) you would be at least as comfortable seeing an NP as you would a physician. Independent of Obama care, which is its own can of worms, the role of NP's has been growing quite a bit and in some states, like here in Nevada, NP's are being severed from their need to have a collaborative agreement with an MD who is supposed to be reviewing the way NP's practice and deliver care.
Ironically, long before I even had the idea of becoming a nurse, the thought occurred to me that it would make sense (from a free market perspective) to have a significant field of "mid level" practitioners who primarily gave basic care such as assessment, schedule labs, review current health and so on. The benefit, I believed at the time, would be that seeing these mid level care givers would be cheaper then seeing a doctor. For specialties and higher levels of care, the MD would remain the primary care giver. Seems like that is coming to pass.
As a nurse, of course, I have a biased view. I've met many doctors who are truly, brilliant people. But, I've also found that despite having extensive training and going through residency programs where they spend time in every aspect of acute care from ER to ICU to Surgery to delivering babies, MD's will eventually settle into a particular specialty and become very dialed into that specialty at the expense of retaining a high level of competency in other areas of medicine. Here in Vegas, I worked with doctors who rounded on patients in the ICU as a primary care doctor, but would not be able to manage the care of that patient if the patient was crashing. At one time, these doctors obviously went through a residency program wherein they did manage ICU patients, but over time, they lose that skill and knowledge. They may be good at their role of primary care, but that extra knowledge required seems lost if not used and retained.
A knock on NP's I have heard is that they are not as well trained as MD's and I have to agree this is mostly true. An NP is never going to have the residency experience of an MD and will not be as cross trained as an MD is while going through school and residency. That said, as a prospective NP student, I will be going for a masters degree AFTER having already worked as an RN for six plus years, with the bulk of that time spent in the ICU. Once I start my clinicals, I wont' be getting a full cross training across the entire life span, but then again, once I am done, I plan to work in the area of my degree, which will be adult and gero populations. I won't be doing acute care, unless I get more education and clinical experience and unlike some NP's, I believe I will be very content staying in that scope of practice.
So, my questions, going back to the top also include what your general beliefs are of NP's. Should they exist? Are they safe? Would you use them?
My parents are in their twilight years and my mother is in very poor health. Her life expectancy is less than a year - of course she has been "there" for about 2 years -.
ReplyDeleteCurrently she has advanced emphysema (22% - 24% of her lung capacity)and her heart is under 30% of its capacity.
In the last 24 months my mother has been taken by ambulance to the hospital 6 or 7 times. Not being able to breath, "a little heart failure", and even an appendicitis were the reasons.
When she see her "doctor" she actually sees a nurse practitioner, Robin. Robin is a bitch with NO bedside manner. It is obvious that my mother has difficulty getting around and Robin loves to send her out for tests , lots of tests. She even wants my mom to have a mammogram - Note that my mom had a double mastectomy years back. Robin doesn't care as she said that it MUST be done or she would not give my mom her prescriptions --one being abian and yes she is addicted to it but then who cares as she is "dying" anyway.
Robin F-up her dosage on her thyroid medication and blames ME for it stating, "her daughter said she needed a specif dosage. ---- I really have NO idea why she tried to use me as her scapegoat but then again Robin is a bitch!
Doctors around here are few and those accepting new patients are non existent so my mom is stuck with this bitch or I mean Dr. Young.
Don't be like Robin...
Nurse practitioners are great for basic needs such as the flu, pneumonia, check backs and such for for other things most people what to see a doctor after all that is what they are paying for.
Emphysema is brutal to manage and my current line of nursing, it is one of the tougher conditions to help people manage as they are getting close to passing away. When I worked in the hospital, I saw the pattern you were describing a lot where people either have an attack of not being able to breath and/or associated heart failure. The can frequently blast someone with a buttload of steroids and use CPAP for breathing and lasix to dump some fluid, but that only works so long. In the spirit of being helpful, you might find better comfort management through a hospice program at some point.
ReplyDeleteIt's unfortunate your Mom's NP doesn't have the bedside demeanor. Seniors are in a bad spot. Most don't have the money to pay for their health care and of course, they don't have the money at a time in life where their health is likely to be at its worst. We've avoided this problem for decades and now that boomers are going to retire in massive numbers, we are going to have a lot of problems. Hopefully as an NP I won't have to work under the HMO conditions that MD's work under. The people that pay their salaries don't want them spending time with patients either.
To be perfectly honest we all thought that she would not have made it this long (mt mom, dad and myself). She is ready to pass and has made her peace with God - I only hope that she goes by stroke in her sleep and not emphysema. Emphysema is the worst that I have seen in that it drags on and on, taking all independence away and slowly kills the one who has it....
DeleteShe does have both private and medicare it is just the lack of doctors around here accepting new patients ... and it is getting worse.. NP are becoming more of the norm so why are the doctors not taking in new patients??
I think that I need a good Chinese herbalist ... i am not joking ...
Max,
ReplyDeleteOpening with a sidebar comment, I think the fact that you will be a 'non-traditional' student, a term I've heard used locally, should be a big plus for you, and probably will benefit other, traditional students.
I had a very small amount of experience with an NP, and it was fine. I guess the only concern, if that is the correct word, is in the area of prescribing medication, and the guidelines underwhich an NP should do that. Likewise, and not knowing what the curriculum covers, and how, is the more general issue of when the NP should refer a patient to a doctor.
It sounds like you have specific goals, referring especially to a limited field of practice. Goals are always good, and in your case, you avoid the problem of not being able to keep up in all fields of practice by concentrating on elderly care.
Not exactly much help, but good luck. I'm sure you'll do well, and it sounds exciting.
Jean
Max.....I have been at a loss for time lately,too much work,no posting time.I do check in from time to time and watch topics.
ReplyDeleteNow as you may have picked up on is the fact that my wife is a Nurse Practitioner with a very loyal following.
Recently she was offered a position with a much larger clinic which was closer to where we live,and a large increase in salary.She accepted.
When she gave her 30 day notice an started informing her patients,many were very sad and some cried.
Her supervising Doctor said he would miss her and that she was the best FNP he has ever worked with.
Nurse Practitioners are not all equal,there are some out there that should not be doing what they are doing.or don't put forth the effort that it takes to excel. It's not a cake walk and requires much time and effort.
Max all I can say is Go For It,but do so with the extra effort that it will take to excel,as I understand you have a good background,that is ICU experience its a plus.
You will find that when you get there it is not a job,it takes a genuine interest in medicine and to really excel, it will become a way of life.
I would like to say good luck,but luck is not an issue it's all hard work.
Later Roger.
The big problem I have with NP is that they are NOT doctors and yet they are doing the job of doctors many times. I am not saying that they are not helpful but they are overused in many cases. Technology they cannot diagnose an illness because that is the responsibility of one who practices medicine - a doctor that is. IMO with the increase of NP we will see a case brought up with this being the key issue behind an overlooked illness/disease.
ReplyDeleteWhere is the line of "practicing medicine" and providing medical care. (I am asking respectfully and am NOT belittling NPs). NPs are great for prescribing medicines for the "basics" such as strep , ear infections, and managing all those little things that come up but they are not a doctor.
Why is this important because;
Sometimes seeing a doctor for one thing can lead him to uncover a another problem not realized.
How can they charge the same price to see a doctor (someone with obviously more training)as they do a NP.
Nurse Practitioners are fine for basic things.
ReplyDeleteBut when it comes to more difficult cases, or something where you don't quite know what is going on with your body etc... Then I would want a doctor.
As our doctor shortage worsens under ObamaCare I see several things occurring.
1.) Greater reliance on NPs
2.) Importing doctors from third world countries.
3.) Government subsidies for people headed in to the medical profession.
4.) Accelerated education programs. Perhaps cutting the length of time required to obtain certain degrees or certifications by 1/3.
Thanks for the responses and encouragement. Been enjoying a week back in Chicago. I've been thinking a bit this week about NPs practicing medicine and where that line should be. The model of medicine, in my experience p, is based on using drugs and procedures while the focus of nursing has been much more focused on a holistic approach that encourages patients to find ways to live healthier. For as much as NPs have ventured into the realm of medicine, consumerism and patient preferences have started to push doctors into adopting a more holistic approach and into being more familiar with herbal remedies.i would tend to believe there are more then a few physicians out there who say to themselves, "I didn't pay five hundred grand to spend a hours listening to a patients life story in order to tailor science with their herbal crackpot desires."
ReplyDeleteWith or without the ACA, there is a shortage of general practitioners in this country. Whether you take insured patients or Medicare patients, it's kinda hard to pay back student loans. I think we should have highly educated practitioners, but I don't think the business model supports it. I personally don't want to practice medicine, which is to say I don't want to just prescribe meds and send people on their way. I think there is a massively under served need for helping people learn how to be healthy. Given how much it costs to complete med school and residency, I think it's unrealistic to expect a doctor to make thirty bucks an hour which is what they would make if they charged fift an hour and laid expenses of running a practice.
Lol, you will all undoubtedly share in my education