Why are MDs more qualified than LPNs?

[st8ic]

Sorry if this isn't in the right area.

 

If a licensed practitioner nurse has 4 years in nursing school, and an MD has 4 years in med school, what makes an MD more qualified?

[bnface]

Sorry if this isn't in the right area.

 

If a licensed practitioner nurse has 4 years in nursing school, and an MD has 4 years in med school, what makes an MD more qualified?

 

More qualified for what? They have different jobs

[rmorelan]

More qualified for what? They have different jobs

 

Exactly

[Jochi1543]

LPNs only have 2 years of post-secondary education in Alberta. MDs outside of Quebec have a minimum of 7 (assuming they started med school after 2nd year undergrad, went to a 3-year school, and did the shortest residency - Family Med) - most people will do 4 years of undergrad and go to a 4-year school, so we're looking at 10 at the min. The two cannot even be compared. If I HAD to randomly pick another health professional whose training might be similar to that of an LPN in terms of breadth of scope/expertise, I'd say maybe primary care paramedic (EMT). Although I agree with whoever posted that they all simply have different jobs.

[ontariostudent]

First of all, admissions standards are very different for nursing programs and MD programs. MD programs look at GPA, MCAT, personal statements, ECs and interviews. When I applied to nursing out of high school it was virtually painless, requiring that I fill out a generic application and send in my high school transcripts. Not highly selective, especially since university is very different from high school.

 

That being said, there are many nurses who COULD be doctors. I almost did nursing, and now I'm becoming a doctor. The reason nurses aren't doctors is that the training is vastly different. I fully agree with what Jochi said with respect to that. By the time I finish my med training I will have at least 12 years of post secondary education under my belt. If a nurse wants to be a doctor, the nurse should retrain as one.

[mrhumble]

LPNs only have 2 years of post-secondary education in Alberta. MDs outside of Quebec have a minimum of 7 (assuming they started med school after 2nd year undergrad, went to a 3-year school, and did the shortest residency - Family Med) - most people will do 4 years of undergrad and go to a 4-year school, so we're looking at 10 at the min. The two cannot even be compared. If I HAD to randomly pick another health professional whose training might be similar to that of an LPN in terms of breadth of scope/expertise, I'd say maybe primary care paramedic (EMT). Although I agree with whoever posted that they all simply have different jobs.

 

+1

 

+1+1+1+1+1+1+1+1+1+1+1+1+1+1+1+1+1+1+1+1+1+1+1+1+1+1

[st8ic]

Could someone explain briefly the difference between an LPN's job and an MD's job? Would you trust an MD to perform as an LPN?

 

In terms of selections standards, I think it's fairly irrelevant when it comes to clinical performance. I don't care that my doctor has a degree in physics with a 3.9 GPA, it's his medical expertise I'm interested in.

 

I live in AB and I have friends who are in a 4-year LPN program (or is that RN?). So however you look at it, both have four years of medical training. Generally they both go directly into their field afterward.

[Jochi1543]

Could someone explain briefly the difference between an LPN's job and an MD's job? Would you trust an MD to perform as an LPN?

 

In terms of selections standards, I think it's fairly irrelevant when it comes to clinical performance. I don't care that my doctor has a degree in physics with a 3.9 GPA, it's his medical expertise I'm interested in.

 

I live in AB and I have friends who are in a 4-year LPN program (or is that RN?). So however you look at it, both have four years of medical training. Generally they both go directly into their field afterward.

LPN is a 2-year program, like I said. In my time as an ambulance worker, I've found that LPN did mostly charting and little patient care. RNs did initial patient evals/triage and contacted the Dr for further instructions. They couldn't do very much on their own without the Dr giving orders. I actually found that our primary care paramedics were much more independent than RNs in their scope of practice. However, a PCP can't, say, assist with casting, care for a bedsore, since they are not trained to do these things (again, different jobs).

 

MD DO have extra years of medical training, called residency (minimum 2 years, can be up to 7, plus potentially fellowships). That residency training makes them an expert in a specific field.

 

Second, as I'm sure our nursing students/former RNs on the board can attest to, the MD and RN curriculums are widely different. I'd encourage you to take a look at the calendars for both programs at U of A or U of C for comparison.

[mrhumble]

Yes, RN and MD curriculums are widely different as Jochi1543 has put it.

 

If you're talking about LPN (Licensed Practical Nurse), they are nurses that have limited scope of nursing practice.

 

I think you guys are confused with LPN and NP.

NP (Nurse Practitioner) program is usually a master's program that teaches an RN to become a mid level practitioner.

 

NP and PA collaborate and help the physicians.

 

Physician's education and training are far superior to those of NP and PA.

[Jochi1543]

MrHumble, can you expand on the responsibilities of NPs? I always hear that they have a bigger scope of practice than RNs and more autonomy, but how much?

[mrhumble]

MrHumble, can you expand on the responsibilities of NPs? I always hear that they have a bigger scope of practice than RNs and more autonomy, but how much?

 

From working with phc-np (family nurse practitioner), I've noticed that they can order lab tests, diagnose and treat injuries and diseases and prescribe medications. They can do almost everything a family physician can do.

However, really complex cases are done by physicians.

 

When I become RN, I cannot do all those. My education, training and license only permits to make assessment for diseases and injuries ( auscultate using stethoscope for various body parts like abdomen, lungs, heart,..., palpating and percussing), use oto/ophthalmoscope to check nose, ears and eyes for diseases, look at the combination of problems and try to see what might be the cause of it, check bp/temperature, look at the physician's medication order and double check if they are right for the patients, and so on (RN scope of practice).

 

There is a government funded primary health clinic run solely by nurse practitioners in Sudbury.

http://sdnpc.ca/

They also collaborate with physicians.

There will be many NP clinics opening up soon to rural areas in the coming years.

[Jochi1543]

From working with phc-np (family nurse practitioner), I've noticed that they can order lab tests, diagnose and treat injuries and diseases and prescribe medications. They can do almost everything a family physician can do.

However, really complex cases are done by physicians.

 

Yeah, and NPs do what, 4 years of nursing school, minimum 2 years practice (or is it 3?), and a 3-year master's - at least that's how it works in Alberta, IIRC. So that's getting comparable for a family physician's length of training.

[mrhumble]

Yeah, and NPs do what, 4 years of nursing school, minimum 2 years practice (or is it 3?), and a 3-year master's - at least that's how it works in Alberta, IIRC. So that's getting comparable for a family physician's length of training.

 

4 years to obtain BScN

Minimum 2 years of experience in intense area like med-surgical, ICU, emergency as RN (More certifications needed to work in such areas) to apply

2 to 3 years MSc NP

 

Physicians have much more clinical hours, training and education.

[leviathan]

While many NPs are highly competent and an asset to underserviced areas of the country, I would not compare their training anywhere near a family practitioner.

 

RN = Only 2 actual years of nursing education at an intensity and focus much less than medical school, and in addition these courses are about nursing, not medicine.

 

MD = 4 dedicated years of medical training at an intensity many times higher than nursing

 

RN = 2 years experience working in an ICU or ER, working 30-40 hours/week following doctor's orders.

 

Family Doc = 2 years experience working 60-100 hours/week managing patient care independently as a resident.

 

Also ICU nursing is great, and some of them are very knowledgable, but critical care or ER is not very relevant to the knowledge requirements of a primary care practitioner in an office setting. They are more helpful backgrounds for people like nurse anesthetists, though.

[medisforme]

While many NPs are highly competent and an asset to underserviced areas of the country, I would not compare their training anywhere near a family practitioner. RN = Only 2 actual years of nursing education at an intensity and focus much less than medical school, and in addition these courses are about nursing, not medicine.

 

FYI:

At smaller universities - a BScN degree is four years of nursing education. The 2 years of studying nursing is only applicable at big universities. As an RN who went to a smaller university and with 4 years work experience (grad - 2005) I can attest to the superior clinical skills (initially after graduation) of those students who went to smaller schools.

 

Furthermore, there are many courses in nursing school with a medical focus although i do not pretend to think that they are anywhere near as difficult as they would be in medical school

ie.

-anatomy

-physiology

-pathophysiology

-pharmacology

[mrhumble]

While many NPs are highly competent and an asset to underserviced areas of the country, I would not compare their training anywhere near a family practitioner.

 

RN = Only 2 actual years of nursing education at an intensity and focus much less than medical school, and in addition these courses are about nursing, not medicine.

 

MD = 4 dedicated years of medical training at an intensity many times higher than nursing

 

RN = 2 years experience working in an ICU or ER, working 30-40 hours/week following doctor's orders.

 

Family Doc = 2 years experience working 60-100 hours/week managing patient care independently as a resident.

 

Also ICU nursing is great, and some of them are very knowledgable, but critical care or ER is not very relevant to the knowledge requirements of a primary care practitioner in an office setting. They are more helpful backgrounds for people like nurse anesthetists, though.

 

Hmm generally right

However, a few things to be corrected:

 

RN = 4 years of education.

Using the stethoscope to assess the heart condition = nursing practice.

There are some mixtures of medicine in the nursing practice and education regardless of what they are called.

As RNs gains more and more 1st hand experience, they become pretty knowledgeable in all sorts of drugs and diseases (in addition to what we've obtained from the pharmacology and pathophysiology <2000 page book> courses we took in the BSCN program).

 

RN working in ICU and ER... it's more like 40-70 hours a week.

...following doctor's orders? Dude, we're like the front line in the hospital.

Many times, we do the assessment, and you make the decisions based on our assessment (even though we may already know what to do).

 

Now, for ER, we need to obtain a special certification (extra courses). We have to have in-depth knowledgeable of pathophysiology, pharmacology, microbiology, anatomy and physiology and assessment skills.

 

Once you enter the NP program, you take at least two advanced pathophysiology and two advanced pharmacology courses in addition to the advanced assessment, diagnosis and prescription skill courses.

 

Type of courses depend on where the NP is specialized in. For Anesthesia NP, anesthesia assistant courses must be completed in addition to the current adult NP program. Once AA courses are done, you take advanced NP anesthesia courses.

[leviathan]

Hmm generally right

However, a few things to be corrected:

Hey humble,

I thought you'd respond to my post!

 

RN = 4 years of education.

Using the stethoscope to assess the heart condition = nursing practice.

That's a physical exam / assessment skill which doesn't really involve anything cerebral. The job of a doctor is to interpret what s/he is hearing and its significance.

 

There are some mixtures of medicine in the nursing practice and education regardless of what they are called.

As RNs gains more and more 1st hand experience, they become pretty knowledgeable in all sorts of drugs and diseases (in addition to what we've obtained from the pharmacology and pathophysiology <2000 page book> courses we took in the BSCN program).

Nurses become familiar with the drugs, and pathology, and most stuff that doctors do. It's just that nurses don't have the same level of comprehension that a doctor does. Example: I've taken the nursing anatomy and physiology course at UBC (a combined course). I also took an anatomy and physiology course for science majors, which was a bit tougher than the nursing one and taught by the same profs who are on the med faculty. Finally, doing physiology in medical school was significantly more in depth than even the science physio course at UBC. It was also a lot more clinical in basis than either the nursing or the science course. To put things into perspective the amount I learned in the nursing course would probably fit into a week of lectures at med school.

 

RN working in ICU and ER... it's more like 40-70 hours a week.

...following doctor's orders? Dude, we're like the front line in the hospital.

Many times, we do the assessment, and you make the decisions based on our assessment (even though we may already know what to do).

No argument there. I'm sure nurses are able to recognize most of the bread and butter problems that they encounter in ICU (well, they should be able to anyhow). But they never get experience actually managing these patients medically. They do have a general idea of what needs to be done though, I don't disagree with that at all. I'm sure a clever veteran ICU nurse with 20 years of experience could handle an ICU on his/her own for a day with the simpler cases (as simple as they can be in ICU), but I'm also sure many mistakes would be made and things would be missed.

 

Now, for ER, we need to obtain a special certification (extra courses). We have to have in-depth knowledgeable of pathophysiology, pharmacology, microbiology, anatomy and physiology and assessment skills.

The nurses I knew in ER were mostly pretty good, but that's being good at their own niche in the emergency department. That doesn't exactly translate to being ready to assess patients, take histories, do physical exams, create a differential diagnosis, order labs, make a treatment plan, etc. I know nurses do the first 3 things (and sometimes order labs / start treatment with standing orders from an MD), but they are not the same depth of treatment that an MD would do. Remember that doctors spend 2 years in med school doing this, and 2-5 more years post-grad...and they STILL usually don't feel ready. How can a nurse say they're ready after learning 2 years of semi-medical material along with 2 years of other nursing courses that are usually full of lots of fluff (trust me, I have friends in 4 different nursing programs who ***** about it). Another couple of years in an NP program will help them, but even that is probably not comparable to the demands of med school. I remember during my paramedic training I assessed a patient who was peeing bright red blood. She had just had a strep throat infection a week prior. I asked my nurse preceptor if she thought it might be post-streptococcal glomerulonephritis. She looked at me funny and laughed, and said "what the hell is that?" Anecdotal, but just shows how nurses don't get a lot of microbiology or pathology training. They are good in the ER at assessing patients and determining sick vs. not sick and usually have a good idea at what initial tests need to be ordered for things like chest pain, COPD exacerbations, etc.

 

Once you enter the NP program, you take at least two advanced pathophysiology and two advanced pharmacology courses in addition to the advanced assessment, diagnosis and prescription skill courses.

That's great, but it just doesn't compare to a physician's level of training. The only reason I piped up is because I do have a major concern with the amount of midlevels and other people like naturopaths that are trying to take a stronghold in treating patients. It's great that NPs are helping bridge the gap in underserviced communities, but already I'm hearing about clinics opening up in towns where family doctors are already working. When misinformation gets spread about how an NP does the same amount of training as a family doc, I have to argue strongly against that, even though I do greatly respect nurses, NPs, and what they do.

[A-Stark]

Nursing practice is really quite different from medical practice. To take one example, from the beginning of first year, med students learn how to take structured patient histories applicable to just about any situation. They (we) are not taught to rely on checklists or simple algorithms, but to have a more free form conversation with the patient.

 

In contrast, most histories I've seen taken by nurses are very specialized (e.g. a liver or HIV clinic) and consist mainly of going through a checklist. It's a bad anecdote, but I once observed a fourth-year student nurse do a history by sitting across the room from the patient, behind a desk, and going through a checklist while barely making eye contact with him. I was suitably appalled, not least because in the physical he missed some major findings that *I* saw and he should've been looking for in that particular patient.

 

Now, I grant that this is just an anecdote, but it seriously calls into question just how "equivalent" nursing training is - insofar as histories are concerned, it obviously isn't. I've no doubt it's much the same for diagnostics... but that's fine, since that's not what nursing is really about as a profession.

[mrhumble]

hmm both of you made good points, and I agree.

[Madz25]

Based on my personal experience thus far:

Medical training teaches doctors to take a thorough history and identify important information from that history and expand on the important aspects. Then do a thorough physical examination and put the history+physical together to develop a differential diagnosis. Based on that differential, determine the most likely diagnoses (not a typo, plural) and order appropriate tests/imaging. Arrive to a diagnosis and treat appropriately, with appropriate follow up. I'm sure all of you already know this.

 

What I've found is that a lot of what happens on a floor once a patient is admitted is the same thing again and again. Patient is fluid overloaded - make them pee it out. Patient is hypovolemic - give them fluids. Patient had a bleed and now has dangerously low hemoglobin - give them blood. Etc etc (these are simplified examples, obviously you would check other things). A lot of the floorwork is just doing the opposite of the patient's problem. Nurses have TONS of experience with this and hence have become familiar with identifyiing these problems and knowing how to treat them appropriately (which meds, doses etc.). In addition, they spend a lot more time with the patients and know when something is "off." However, when it comes to a novel situation and trying to put things together and figuring out what could be causinig the problem in the first place (and treating it appropriately) - I feel only medical training can prepare someone for that.

 

Sorry if people found this offensive in any way. The two jobs are different because they are trained to do different things!

[blindsideflank]

i am appaled at some of the responses here. i work with a lot of ER nurses and in many cases i have seen them blow doctors away (experience>education). its too easy to point out the obvious that docotrs have a wider scope of practice and more education but you people sure talk down nurses. for example, saying they cant take histories and that you saw a nurse not even make eye contact... when i did my clinical, i had a n ER doctor showing me a carotid sinus massgage on a terminal geriatric with exgtensive heart disease hx. he flatlined but came back quickly with the atropine that the nurse grabbed, i beleive the massage would be considered risky in any pt with bruit (and this pt had it) but he seemed like he felt the need to show off.

moral..there are good docs and bad docs

good nurses and bad nurses

 

also, in my experience docs are the ones that are the least personable and run through the motions, give a generic treatment then if sh** hits the fan they finally take notice

 

no hate on either just thought id give a different perspective

[The_B]

Hmm generally right

However, a few things to be corrected:

 

RN = 4 years of education.

Using the stethoscope to assess the heart condition = nursing practice.

There are some mixtures of medicine in the nursing practice and education regardless of what they are called.

As RNs gains more and more 1st hand experience, they become pretty knowledgeable in all sorts of drugs and diseases (in addition to what we've obtained from the pharmacology and pathophysiology <2000 page book> courses we took in the BSCN program).

 

I hate to correct what a nurse says about their own education, but, at least in Ontario, nursing is roughly a year and a half program.

 

Now before people cry foul, let me explain.

 

There are a few fast track nursing degrees for those who already have a degree (I know, I was accepted to one, and one of my best friends finished one). In that 18 months, you can become a licensed RN. The 18 month program eliminates a lot of the non-nursing aspects of ones degree, as they are expected prior to being accepted. The actual amount of nursing taught was done in 18 months.

 

And for the record, my friend learned what she needed, and immediately started work in a tertiary care ER, so I know that they didn't "skip" anything.

[leviathan]

i am appaled at some of the responses here. i work with a lot of ER nurses and in many cases i have seen them blow doctors away (experience>education). its too easy to point out the obvious that docotrs have a wider scope of practice and more education but you people sure talk down nurses. for example, saying they cant take histories and that you saw a nurse not even make eye contact... when i did my clinical, i had a n ER doctor showing me a carotid sinus massgage on a terminal geriatric with exgtensive heart disease hx. he flatlined but came back quickly with the atropine that the nurse grabbed, i beleive the massage would be considered risky in any pt with bruit (and this pt had it) but he seemed like he felt the need to show off.

moral..there are good docs and bad docs

good nurses and bad nurses

True. But overall, doctors >>> nurses in terms of MEDICAL knowledge. Sorry, I don't know why anyone feels the need to even argue this or get offended by a fact of life. If you argued that a DO wasn't as smart as an MD, that would be a fair reason to be upset.

 

Nursing and medicine are completely different jobs, albeit with a few common goals in mind. A doctor wouldn't be offended if you said he didn't know how to do the job of a nurse, so why is the opposite such a touchy subject?

[mrhumble]

I hate to correct what a nurse says about their own education, but, at least in Ontario, nursing is roughly a year and a half program.

 

Now before people cry foul, let me explain.

 

There are a few fast track nursing degrees for those who already have a degree (I know, I was accepted to one, and one of my best friends finished one). In that 18 months, you can become a licensed RN. The 18 month program eliminates a lot of the non-nursing aspects of ones degree, as they are expected prior to being accepted. The actual amount of nursing taught was done in 18 months.

 

And for the record, my friend learned what she needed, and immediately started work in a tertiary care ER, so I know that they didn't "skip" anything.

 

From what I gather, in order to be accepted into the 2 year nursing accelerate program, you need to have a degree with specific science pre requisite courses.

 

True. But overall, doctors >>> nurses in terms of MEDICAL knowledge. Sorry, I don't know why anyone feels the need to even argue this or get offended by a fact of life. If you argued that a DO wasn't as smart as an MD, that would be a fair reason to be upset.

 

Nursing and medicine are completely different jobs, albeit with a few common goals in mind. A doctor wouldn't be offended if you said he didn't know how to do the job of a nurse, so why is the opposite such a touchy subject?

 

I don't think anyone is saying that nurses have more medical knowledge than MDs.

 

It's just that some people are sick of disrespectful doctors who talk down on nursing profession and severely underestimate the knowledge that the nurses have.

 

It's no prob though.

 

I don't associate myself with those kind of egotistical idiots anyways.

[leviathan]

It's just that some people are sick of disrespectful doctors who talk down on nursing profession and severely underestimate the knowledge that the nurses have.

That's not cool, but at the same time if I make some comparisons between the professions, people think I'm disrespecting their profession (not saying that's you). Then they use some random example where a nurse knew something a doctor didn't, and use that to somehow prove the nurse knew more than that doctor. We're all on the same team and need each other to do our jobs. Can't we all just get along? (OK, now I'm starting to sound really cheesy...)