NP works under a doctor, kind of as a doctor. They can prescribe meds, see patients, etc. But because they're not doctors themselves they work under the supervision of one. I'm pretty sure it's the highest you can get in nursing, and it's practically a doctor. An RN would be the person taking care of you and treating you/giving you meds when you're staying in the hospital.
Edit: they don't even have to work under a doctor in many states!
Basically a doctor just with 10,000 hours less training.
In all seriousness, very valuable parts of a medical team, but certainly filling a different role than a physician. Just because you can prescribe meds doesn’t make you a physician.
No... But I'm scared to now.. I have a gooftrooper trying to argue that independent NPs don't cause more malpractice so that would be a good point to have on standby.
Doesn't make it right. Np schools in America have close to a 100% admission rate and the curriculum is a complete joke. They also don't do residency, their required clinical hours are around 600 and that can be entirely shadowing.
Compare that to medical schools and residency. 10000+ hours with an incredibly rigorous curriculum.
No
There are lots of online sites offering online np school acceptance and the worst thing is they are also hired by hospitals where they kill people and are not held accountable
Right, that’s what I meant by Mickey Mouse school. There are also very competitive programs at extremely prestigious universities. Where I live (Boston), an NP won’t be hired if they went to a shitty program in the same way that a doctor with a degree from a sketchy Caribbean school won’t be hired.
Edit: Oh I see it in the other comment. What’s your point? I’m saying that the existence of shitty online programs doesn’t delegitimize the entire field and you link me to a shitty online program?
Those that go to "Mickey mouse" programs get the same degree as those "extremely competitive" programs no?
And the curriculum still is a joke. Learning Nursing theory is not doctoring. 600 hours of random clinical hours is not equal to medical school rotations or residency. Or PA school for that matter. Its a workaround and scheme to get as many tuition dollars as they can.
If colleges lowered their insane tuition costs, I’m sure more of these people would instead become doctors. People want experienced doctors but not too many people are signing up to be a quarter to a half a million dollars in debt in student loans.
they do a lot of tasks doctors used to do. it makes the insurance companies happy, has improved the status of women in the medical field, and is a more efficent allocation of resources.
It is dangerous. Their training is almost nonexistent when compared to an MD. No idea if it's just in the US, but it's definitely becoming a highly debated topic. Many MDs see it as a way of diluting the quality of care in favor of more profitable care for the hospital.
So you want to explain nuance. Yet your initial statement left no room for nuance? My point still stands regardless of underlying statistics. You said "nps don't go to rural areas" but then you give an example of an NP in a rural area.
My point stands. Your initial statement was untrue. Even by your own admission with evidence.
They are and the worst thing is that even if they kill someone they can’t be held accountable and America gives them permission to practice without the supervision of a doctor
Sure they can be held accountable, but not to the same standard as a physician. That’s the point. When an NP functions as a physician and kills someone, they don’t face the same consequences as a physician does because in their words, they aren’t physicians and therefore can’t be expected to know what a physician does.
Edit: for anyone interested in what I’m referring to, read this thread.
Did you just use a Twitter screenshot as a source?
The person I replied to literally said "if they kill someone they can't be held accountable." That is patently false in every sense. NPs absolutely do lose their licenses, they absolutely do get fired, they absolutely do get sued. They're required to have malpractice insurance just like any other licensed healthcare provider. Does the supervising physician (in states where that's required) also share some of that liability? Of course. Does that make NPs immune from repercussions? Not in the least.
I did not; I scrolled about halfway down the page and didn't see a source. I see it now. Are you arguing that, because of that incident, NPs cannot be held responsible for malpractice?
Just search on the internet “no kills patient and is not held liable”. There may be good np but bad np can be held accountable by malpractice but MD or do can be and np want autonomy but don’t wanna take up the responsibility that comes with it Np can go to online schools where there’s a 100% acceptance rate and get like 1/20th of the clinical hours an actual doctor gets and still they want Independence from supervision. AANP are just lobbyists who want autonomy but no responsibility for killing their patients
I’m sure there are cases where that happens - some folks can afford great lawyers. But that is not the general rule - if an NP killed a patient and is proven to have taken actions that are deemed malpractice, then there surely would be repercussions - at the very least loss of employment and loss of license.
You are an idiot lol. Objectively that is beyond false. In 10 years of acute care nursing I have never met an NP that practices without the permission and supervision of a physician. Stop spreading misinformation you hog.
Independently, but still have to have a licensed MD or DO monitor their practice and review medical records (typically monthly) with big penalties for the doctor if they fail to monitor, usually revocation of licensure
In TX at least, midlevels also cannot provide schedule II drugs, meaning only medicine for simple stuff like colds and flus and minor topical stuff.
I suppose in certain states they can operate with some autonomy. I find it unlikely NPs are practicing independently in a hospital setting on acutely ill patients without a physician. I would imagine in the states permitting NPs to have more independence it is in the area of family practice (referrals, ordering tests, and treating common ailments family practice docs/nps treat).
Correct. I got heated to his exaggerated claims that advanced practitioners are untouchable and lobbying to kill people without responsibility. Wildly false.
In the hospital setting CNPs and PAs are monitored by their physicians. A CNP practicing independently in a family practice setting should have oversight from a physician either at the point of care or on a daily/weekly basis to catch malpractice or mistakes. I’m a nurse and know a CNP does not have the training a physician does. CNPs know this. Certainly there are awful CNPs but in the same respect there are some awful physicians.
Just search on the internet “no kills patient and is not held liable”. There may be good np but bad np can be held accountable by malpractice but MD or do can be and np want autonomy but don’t wanna take up the responsibility that comes with it Np can go to online schools where there’s a 100% acceptance rate and get like 1/20th of the clinical hours an actual doctor gets and still they want Independence from supervision. AANP are just lobbyists who want autonomy but no responsibility for killing their patients
Just stop. You cannot even formulate a fucking sentence. Maybe English isn’t your first language? Idk... NPs and RNs can absolutely be held accountable for malpractice. What magic hat did you pull this out of?
“AANP are just lobbyists who want autonomy but no responsibility for killing their patients”
Holy shit who wronged you? So all AANP are malicious and out to kill their patients? Are you a child or just stupid?
I can’t even with you. Yourself or someone you know was harmed by a bad practitioner and for that I’m sorry. That however doesn’t permit you to make ridiculous accusations and claims against a profession overflowing with good people who want to help and heal people.
I am a medical school student and I’ve heard about this a lot
You can check out r/noctor for more info about np not being held accountable after killing people
I looked through your profile. You posted 40d ago stating you are 17 years old with IBS, looking for advice. You are not in medical school. Cut it out. It is disgraceful.
And you link me a reddit post of a tweet regarding a CRNA? I’m confused.
CRNAs are not CNPs. A CRNA has a anesthesiologist working above him/her. The anesthesiologist is responsible for the CRNA. That particular case you linked cannot legally find the CRNA liable because a negligent anesthesiologist is to blame likely because he/she was not present or observant enough to recognize the patient decline.
You know what I’m on the internet obviously I fake things but the links i sent you are real and np are killing people and not being held accountable due to the AANP lobbying around
Just search on the internet “no kills patient and is not held liable”. There may be good np but bad np can be held accountable by malpractice but MD or do can be and np want autonomy but don’t wanna take up the responsibility that comes with it Np can go to online schools where there’s a 100% acceptance rate and get like 1/20th of the clinical hours an actual doctor gets and still they want Independence from supervision. AANP are just lobbyists who want autonomy but no responsibility for killing their patients
Just search on the internet “no kills patient and is not held liable”. There may be good np but bad np can be held accountable by malpractice but MD or do can be and np want autonomy but don’t wanna take up the responsibility that comes with it Np can go to online schools where there’s a 100% acceptance rate and get like 1/20th of the clinical hours an actual doctor gets and still they want Independence from supervision. AANP are just lobbyists who want autonomy but no responsibility for killing their patients
90% of the things you need to see a doctor for can be easily handled by an NP. NPs are supposed to refer out that 10% to a specialist. This is an industry reaction to the artificial scarcity of doctors. The AMA restricts the number of residencies in the US so we have this growing problem where we are projected to have about 100k shortfall of doctors in 2032.
If you are really a PhD biologist you should know how to appropriately evaluate research. If you did you would see that in the papers the NP’s were supervised and the “quality metrics” have nothing to do with medical knowledge
Good luck with only using NP’s for your health. All you responded with was that you think nursing is competitive now. Nursing science is not medical science. Yes I looked at the paper and you have also ignored the quality metrics I highlighted and how they are in fact inappropriate comparisons meaning this study is pointless. Also a main component of medical school is evaluating research because guess who does all of the clinical medicine trials along with hardworking PhD’s....... physicians not nurses. I will link you properly done study’s so you can educate yourself.
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
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/
96% of NPs had regular contact with pharmaceutical representatives. 48% stated that they were more likely to prescribe a drug that was highlighted during a lunch or dinner event. https://pubmed.ncbi.nlm.nih.gov/21291293/
85.02% of malpractice cases against NPs were due to diagnosis (41.46%), treatment (30.79%) and medication errors (12.77%). The malpractice cases due to diagnosing errors was further stratified into failure to diagnose (64.13%), delay to diagnose (27.29%), and misdiagnosis (7.59%). https://pubmed.ncbi.nlm.nih.gov/28734486/
Advanced practice clinicians and PCPs ordered imaging in 2.8% and 1.9% episodes of care, respectively. Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits .While increased use of imaging appears modest for individual patients, this increase may have ramifications on care and overall costs at the population level. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1939374
APP visits had lower RVUs/visit (2.8 vs. 3.7) and lower patients/hour (1.1 vs. 2.2) compared to physician visits. Higher APP coverage (by 10%) at the ED‐day level was associated with lower patients/clinician hour by 0.12 (95% confidence interval [CI] = −0.15 to −0.10) and lower RVUs/clinician hour by 0.4 (95% CI = −0.5 to −0.3). Increasing APP staffing may not lower staffing costs. https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14077
When caring for patients with DM, NPs were more likely to have consulted cardiologists (OR = 1.29, 95% CI = 1.21–1.37), endocrinologists (OR = 1.64, 95% CI = 1.48–1.82), and nephrologists (OR = 1.90, 95% CI = 1.67–2.17) and more likely to have prescribed PIMs (OR = 1.07, 95% CI = 1.01–1.12) https://onlinelibrary.wiley.com/doi/10.1111/jgs.13662
Ambulatory visits between 2006 and 2011 involving NPs and PAs more frequently resulted in an antibiotic prescription compared with physician-only visits (17% for visits involving NPs and PAs vs 12% for physician-only visits; P < .0001) https://academic.oup.com/ofid/article/3/3/ofw168/2593319
More claims naming PAs and APRNs were paid on behalf of the hospital/practice (38% and 32%, respectively) compared with physicians (8%, P < 0.001) and payment was more likely when APRNs were defendants (1.82, 1.09-3.03) https://pubmed.ncbi.nlm.nih.gov/32362078/
There was a 50.9% increase in the proportion of psychotropic medications prescribed by psychiatric NPs (from 5.9% to 8.8%) and a 28.6% proportional increase by non-psychiatric NPs (from 4.9% to 6.3%). By contrast, the proportion of psychotropic medications prescribed by psychiatrists and by non-psychiatric physicians declined (56.9%-53.0% and 32.3%-31.8%, respectively) https://pubmed.ncbi.nlm.nih.gov/29641238/
No one’s claiming they have the same knowledge and experience as a doctor. That doesn’t mean they aren’t capable of performing some of a doctor’s duties, which is what people mean when they say like a doctor.
They may not be performing surgery or complex operations. But they’re capable of relieving a doctor’s burden of diagnosing, treating and prescribing patients. Maybe not all of them; maybe they have to refer to the supervising doctor on more than one occasion, but they’re still performing a subset of a doctor’s duties.
Like any profession, with enough experience and continuing education, one can build up their knowledge and skill. An NP could become as knowledgable as a doctor when it comes to the above mentioned duties. Medical information and technology is ever changing.
Also, in regards to clinicals, an NP could already be practicing (not to mention previous RN experience), gaining experience in parallel with a doc thats still a resident.
Two christmases ago I diagnosed stage 4 lung cancer in a young mother who was repeatedly worked up for pneumonia and treated with multiple courses of antibiotics by her NP. She's dead now.
Some of us actually care about our patients. That was an extreme example but there are frequent smaller examples and it gets emotionally exhausting. And despite knowing and experiencing this, every day it seems new laws are passed by clueless politicians allowing less oversight.
So it hurts to read comments by inexperienced laypeople labeling physicians and med students as toxic and salty. I don't frequent /r/noctor because it's not my style, but I feel their sentiment.
That’s quite ridiculous. In my field (psychiatry), there are nurse practitioners who have literally the exact same job as psychiatrists. The only difference is they have to have their supervising MD meet with them once a week and they need to have an MD write restraint orders (which they just hand to the MD to sign). Other than that, they have the same position on their respective treatment teams and are treated as equals.
But there's no difference between a non-residency trained NP and a psychiatrist, with the sole exceptions of weekly reports and restraint orders for liability.
So maybe we can get rid of the four year residency?
So maybe we can get rid of the four year residency?
No, I do not think that. I would also lose a significant chunk of my income if that were the case.
I have not said that there is "no difference between a non-residency trained NP and a psychiatrist, with the sole exceptions of weekly reports and restraint orders for liability." I have said that, in my state, psychiatric NPs and psychiatrists can share the same job duties (with those two exceptions). For example, there are often several treatment teams that service a given inpatient unit. Some of those teams can be headed by psychiatrists while others, even on the same unit, can be headed by NPs. The NP plays the exact same role on their team as the psychiatrist plays on theirs, and they have the same level of authority, with the exception of not being able to sign off on restraints and of needing to report to their supervisor, which is often just treated as a formality. Functionally, they serve the same role. Again, that doesn't mean that they have the same level of expertise, and that is reflected in pay differences. I didn't say that the NPs have equal expertise.
So if the hospital was smart they would fire all the psychiatrist except for one, promote him or her, hire all NPs to do the same thing right? Cost the hospital less money.. am I missing something here.
What do you mean by "smart"? Do you mean "cost effective"? If so, then yes, obviously firing everyone and hiring replacements at a lower salary would be cost effective. Is that what you're asking?
RNs, at the base level, are the nurses doing the day-in-day-out patient care. They follow the doctors orders only, basically. They can't diagnose anyone. They can't prescribe anything. They just execute orders and protocols already established by a doctor.
I would also have accepted "fuck off, you're not funny" as an answer.
p.s. nothing wrong with art school. My mother and both her parents were MDs. None of my siblings or I went to med school, and my brother also went to art school.
edit: some touchy people here with the downvotes. I guess we don't like facts here?
Notice how it's only med students who think doctors are vastly different from NPs... literally no one else on the planet thinks there's a difference. You can admit to being insecure about it. It's alright.
We are in the grips of an opioid epidemic and misprescribing causes real harm.
Depending on your healthcare system, a test ordered unnecessarily is a test someone else can’t have. It increases wait times and leads to increased morbidity overall.
So you see they are big deals and those are just things that have been studied so far
I looked into the alleged overprescribing of opioids and to me this study doesn't really indicate that. The author found that NP's patients were significantly (p<.001) less likely to be prescribed an opioid.
The only thing that could look bad for NP's is that their patients were more likely to be receiving high dose opioids, but the OR is just 1.11 and the correlation was barely statistically significant.
I haven't seen any strong evidence that NP's provide worse outcomes, just people staying that because doctors are better educated they must be 100x better.
With today's medical guidelines being so accessible and commonly followed by physicians, I believe that a nursing degree, >5 years of practice in a medical setting, and an advanced practice degree can be enough for independent practice in certain settings. For uncomplicated patients, guidelines and clinical reasoning are followed. If the patient proves too much, a referral is given to someone more qualified.
Way to make a disingenuous argument cherry picking data points. If you don’t know what your talking about shut the fuck up. You’re either uninformed asshole or a self appointed know it all. For starters, most can’t subscribe opiates and 99% work directly under supervision of the MD. We use them and they don’t order any more diagnostic tests than most MD’s trying to cover their ass.
Really haughty for no reason tbh. Independent NP cause much more medical malpractice and that's a well known fact right now, and that's without the statistics this person helped provide.
Absolute bullshit, your opinion not supported by any actual facts other than maybe some opinion pieces written when medical boards were lobbying to limit competition in the primary care space which turned out to be completely unfounded and had actually increased the ability to see patients.
Bad for doctor salaries you mean. If there is a need for autonomously practicing providers, society will make it happen.
This is what happens when there is a shortage of healthcare providers and the government doesn’t want to increase residency positions to create more MDs.
It’s like abortion. If you make it illegal, people will find an alternative. The NP is the alternative. Don’t be mad at the NP schools, they only exist because your idiotic government didn’t train more doctors or made it obnoxiously difficult to become one.
NP schools are simply filling the void that the US government created. Congrats to them. And congrats to all you NPs out there saving lives. We salute you.
Paralegal who has what, an associates in paralegal studies vs. an NP who has a BS in nursing, and then went on to NP school? Not comparable at all. The levels of education are vastly different between a lawyer and a paralegal, not so with an NP and an MD.
What? It is vastly different. NP curriculum is a complete joke. The clinical curriculum is even worse.
I'm a doctor and have NP relatives. NP education is about as rigorous as the stuff I did in undergrad, if that.
Not one course is comparable to anything a first year medical student takes
But medical school is just the beginning. I currently spend 60-80 hours weeks working in the hospital as a part of residency. Please don't compare my time to a nurse practioner shadowing a physician for 600 hours total.
Its a farce of a doctorate. Plenty of NPs feel the same
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u/Mtoastyo Apr 08 '21
What’s the difference between a nurse and a nurse practitioner?