Stop the nurses before it's too late

[hippie]

.........................

[infomeddude]

Ugh.. I hate MD wanna be's... they got nothin on us

[mrnursing]

Stop them evil nurses.

[greeny]

Ugh.. I hate MD wanna be's... they got nothin on us

 

you are an MD wannabe

[Spleen Spirit]

Stop them evil nurses.

 

 

[lostintime]

I just don't understand why having nurse practitioners helps save the government any money (besides the training).

 

They are unionized, so they work less hours, probably < 40 hours / week (and of course this isn't referring to all the overtime hours they get paid like 1.5x or 2x etc).

 

So they work LESS, get paid well > $100k which isn't that far off from what a family doc makes, and how exactly is this saving the government money? They make slightly less than a family doc and work WAYY less....

 

And I haven't even touched patient safety yet...

 

And seriously, while I don't think having an MD makes you any more superior than the other doctorates, it's plain stupid that they want patients to call them "doctor" in a CLINICAL setting. How confusing is that for a patient?!

[mrnursing]

I just don't understand why having nurse practitioners helps save the government any money (besides the training).

 

They are unionized, so they work less hours, probably < 40 hours / week (and of course this isn't referring to all the overtime hours they get paid like 1.5x or 2x etc).

 

So they work LESS, get paid well > $100k which isn't that far off from what a family doc makes, and how exactly is this saving the government money? They make slightly less than a family doc and work WAYY less....

 

And I haven't even touched patient safety yet...

 

I've worked with nurse practitioners in the community setting in Ontario.

 

They get paid around $80,000/year. As far as I know, NPs aren't unionized here (I've talked to a few applicants). I may be wrong though.

[sfinch]

This is serious! I encourage EVERYONE: medical students, residents, attendings, pre-meds, and the lay public to send letters of concern to the CMA, the FRCP, FRCS, and CCFP, your provincial health ministry, and the prime minister. It's bad in the US. We have to SQUASH this before it has the chance to come to fruition here in Canada.

 

Having nurses and physician assistants expand their practice breadth through legislation, and not by training and instruction, is DANGEROUS for patients, and speaks POORLY for our profession. Not only will patients be exposed to harmful intervention(or lack thereof) but it will partially be OUR OWN FAULT for not stopping this before it gets out of hand.

 

The NATUROPATHS have already secured independent practice rights in BC! They can essentially be family doctors, except they can't prescribe narcs. Yes. Four years of medical school and two of residency so you can prescribe narcs! HOW DID WE LET THIS HAPPEN?

 

The NATUROPATHS are trying to push forth legislation in Ontario, called BILL 179, granting them the same rights. The ministry of health and long term care supports it(!!WTF!!!?). It just has to be signed by the legislature. WE MUST STOP THEM!

 

It's sad that the government's solution to the primary care shortage is to lower the standards of who can provide such care. This is horrible.

 

One of the things alot of people do not appreciate is that doctors in general are 'good' partially because they are selected. Getting into medicine is one of the hardest macro-profession to get into, and it is one of the few that is largely based on merit (not entirely of course, but largely). Hence the Canadian medical school grad from Toronto or UWO or Queen's can generally be considered to be among the top.

 

Getting into nursing, or naturopathic college, or what not, is easy. Inherenent intelligence, or even hard work, is not necessary to get in. Now of course many will be hard working ,and smart, but on average compared to medicine, it is simply not the case. So even if these people are trained at the same level as doctors (which they are not), they will on average have less knowledge retained and less inherent skill.

 

I am talking about averages. The average person in medicine is inherently smarter/more accomplished/hard working than the average person in nursing, naturopathic college, or whatever. And ON AVERAGE, that will be reflected in their ability to practice in whatever job they end up doing.

[lostintime]

Wasn't there a recent report where there were like >1000 nurses in Ontario paid > $100k or something? I heard that the average for NP's was > $100k, but if anyone has stats or links, that would be great.

 

But yeah, EVEN if that argument holds still, I think it would be more worthwhile just to shorten undergrad so people can enter med school earlier than get this whole nurse-doctor hybrid thing going. The hybrid isn't necessarily a bad idea IF strict guidelines were imposed, but everyone has a personal agenda and it's not doing patients any good.

[mrnursing]

Wasn't there a recent report where there were like >1000 nurses in Ontario paid > $100k or something? I heard that the average for NP's was > $100k, but if anyone has stats or links, that would be great.

 

But yeah, EVEN if that argument holds still, I think it would be more worthwhile just to shorten undergrad so people can enter med school earlier than get this whole nurse-doctor hybrid thing going. The hybrid isn't necessarily a bad idea IF strict guidelines were imposed, but everyone has a personal agenda and it's not doing patients any good.

 

Average salary for NP is not $100K. Not even in US. It's around $80,000.

 

PA will get paid more when the program finishes its pilot program at around $90,000 starting salary.

 

Those experienced RNs who made over $100,000 worked crazy overtime hours to do it.

 

Experienced RN with a bit of overtime will probably make more than NP.

[Jochi1543]

Dunno about that pay, I've killed a lot of on-call hours at my EMS job reading union agreements and the RNs make a good amount of money. Wages for STUDENT nurses here are at $25-26/hr, and licensed RNs start at around $30, with the pay, of course, progressively increasing with seniority. I think they topped out at something like $42. That's 70 grand a year for a fresh nursing grad working 48 hrs/wk, not bad at all, especially in rural areas where they spend 80% of the night shift eating donuts.

[mrnursing]

Dunno about that pay, I've killed a lot of on-call hours at my EMS job reading union agreements and the RNs make a good amount of money. Wages for STUDENT nurses here are at $25-26/hr, and licensed RNs start at around $30, with the pay, of course, progressively increasing with seniority. I think they topped out at something like $42. That's 70 grand a year for a fresh nursing grad working 48 hrs/wk, not bad at all, especially in rural areas where they spend 80% of the night shift eating donuts.

 

I'm sure that you can somewhat relate to me as former-EMS, but the job ain't easy for RNs.

 

I eat donuts, but only during my breaktime after performing backbreaking work.

[UTPEOPLE]

I'm sure that you can somewhat relate to me as former-EMS, but the job ain't easy for RNs.

 

I eat donuts, but only during my breaktime after performing backbreaking work.

 

so true... I always feel bad for the nurses who have to transfer the 300+ pound patients from bed to bed. That said, I dont think that the work nurses do (plus the relatively shorter training they go through) warrants the same wages and prescribing privileges as doctors do. At least until they bump up their amount of training. 4 years of undergrad + 4 years med +2 year residency for fam med means that at the very least, nurse practionioners who want to be recognized as medical associates better demonstrate at least 4 years of experience as a nurse, and be forced to write the same licensing exams as doctors.

[seeking1]

mrnursing, can you give me a rundown of what the education is like for advanced nursing degrees? I'm starting to wonder if people want to see MDs as the people who hunt zebras, and have nurses being the ones doing primary care.

[mildoc1]

I'm a RN with a MN in Advanced Practice, not a NP though. I did a BScN in BC, worked for 1.5 years in a CCU at VGH then joined the military and did my MN. My MN was a course based program and it was a lot of work, though definitely not comparable to MD training by any means.

 

I wouldn't discount NPs entirely. They can compliment the health care team and have served essentially as GPs in underserved areas since the 70s. I think they should be paid more according to the additional responsibility they undertake and I think that they should earn more then PAs as they are working under their own licence. There is a NP in the thoracic ward at the HI in HFX who is responsible for teaching the med students when they are placed there. However I don't think their pay should be on the same scale as physicians.

 

NPs in Canada have a Masters degree as Nurse Practitioners. It's a FT 2 year degree with advanced courses in patho, pharm, A & P and many supervised clinical hours. In order to be accepted into the programs you need considerable experience as a RN. Positions can be unionized or not, depending where you work (hospital vs. government for example).

 

Personally, I choose to see a NP as my primary health care provider, as do several friends in medical school.

[Tango Charlie]

 

 

 

One time, I went to see a nurse practitioner, and she turned me into a newt!

[A-Stark]

I wouldn't discount NPs entirely. They can compliment the health care team and have served essentially as GPs in underserved areas since the 70s. I think they should be paid more according to the additional responsibility they undertake and I think that they should earn more then PAs as they are working under their own licence. There is a NP in the thoracic ward at the HI in HFX who is responsible for teaching the med students when they are placed there. However I don't think their pay should be on the same scale as physicians.

 

The key word there is "team". NPs absolutely have tremendous value in "underserved" areas and as part of collaborative, team-based care. Employing them as family physician substitutes does little to nothing to improve access to care or save money; the evidence simply isn't there, and the US experience is NOT instructive for us. We also need nurses practising within the existing scope of nursing practice. It's hard to see where the necessity for further "scope of practice creep" is coming from.

 

And, as an aside, the thoracic unit is at the VG, not the HI.

 

NPs in Canada have a Masters degree as Nurse Practitioners. It's a FT 2 year degree with advanced courses in patho, pharm, A & P and many supervised clinical hours. In order to be accepted into the programs you need considerable experience as a RN. Positions can be unionized or not, depending where you work (hospital vs. government for example).

 

Personally, I choose to see a NP as my primary health care provider, as do several friends in medical school.

 

I don't know anyone who sees an NP for primary care, especially when I can (and just did today) obtain a same-day appointment at the Dal clinic. What kind of call do NPs do during their training? Afterwards?

 

Exactly!

[mildoc1]

You're right. Sorry forget that the unit was at the VG. If you've ever worked with L you know how amazing she is.

 

I agree with you completely that we need nurses to work within their nursing scope of practice. Where I work my scope of practice includes ABGs, first assists in Sgx, and assisting with induction. I do however think NPs improve access to care and cost the system less.

 

That's nice that you can get a same day appt. Since I moved to Ottawa, I can't find a GP who is able to take my two children (both 5<) into their practice. My husband and I both fall under the CF health system, but our family is left high and dry.

[UTPEOPLE]

i don't think very many people would pick a NP/PA over an MD. i sure as hell wouldn't. not that i have a thing against them, but why NOT go to a proper doctor, who went to med school......i mean it's like buying genetically modified watermelons, when organically grown ones are available in the same aisle at the same price - it's stupid.

 

and i agree with sfinch. i am sure that NPs are awesome people who have worked very hard to get to where they are in life and a lot of nurses have just as much experience as doctors (after MANY years) but i don't agree with it. maybe it's the pre-med in me, who knows....but i think that if a nurse wants to be able to prescribe, why not have a program especially for them where they get into med school with more ease or something, like create separate seats for them. at least that way care can be standardized. but i suspect a lot of people who are used to seeing doctors will continue to see doctors anyway. health is one thing not a lot of people take a gamble with.

 

what i don't get is why they don't just increase seats for med school rather than resorting to this. it makes no sense.

 

because doctors cost more to hire and train. NP will save the government money... but then you gotta think... all that money in doctor training has got to be doing SOMETHING. As for standardization, perhaps NPs can also be subjected to residency training + the licensing exams to standardize things a little? but that still seems unfair for the people who had to fight to get into med and survive 4 years of grueling material...

[Dongzhuo]

You guys bring up good points. I don't think we are going to be largely affected by NPs. Reason being, who in their right mind would want to have their health matters decided by a NP when they could just as well choose an MD. We would always get first dibs. However, I fear they could do a low ball move, and suggest they give you more of their time. 40 minutes per patient vs the usual 10-15 for an MD- so this might get people to opt for the NP.

 

The woman who said that calling nurses Dr's is not confusing just like calling vets Dr is not confusing. Excuse me? With that kind of intellect I'm starting to get scared.

[UTPEOPLE]

yes they cost more to hire and train - but look at how much money is being poured into this NP program in the states - they could use the same funds and increase seats for med. and yes just asking them to do residency + exams is still unfair.

 

this sounds sketchy to me, and like a shortcut. what's more shocking is that a lot of people who are nurses have like, mid-50, mid-60s grades in high school, join a COLLEGE which is affiliated with a university (eg. humber college in toronto which is affiliated with some university in NB (??) i think)and get a UNI degree. after which they can go on to train and become a NP.

 

i'm not saying they are all like that - a lot of them are extremely smart and just choose nursing. i'm just saying that there will be people like that as well, who can take that path.

 

and then you get people who had straight 90s in high school, and 3.7-4.0 grades in undergrad getting turned away from med and doing things like rad therapy or something. it's NOT fair and it shouldn't be allowed. i'm sure in accounting if someone with a regular accounting degree was given the same power as a CA, there would be a lot of upset people. same deal. there is a difference in the roles for a reason.

 

I agree ( though I have NO idea what the difference between an accountant and a chartered accountant is, does the chartered part mean that they are reserved by a company or something? like a chartered bus? ). Imagine the unfairness if the NP route becomes a way for a certain, substandard subset of scheming undergraduates to access the prestige and benefits of a MD without having to worry about having to prove as intensely that they have the intellectual and interpersonal skills to make it? For the motion to pass, I believe that the government will first have to convince voters that NPs are equivalent to MDs in terms of competency, and that is going to be a hard sell (unless comparing a NP with 20 years of experience with a newly minted doctor, but even in that circumstance, I think I would trust my doctor to explain to me the mechanism of the drug that I'm taking and why I should refrain from certain activities while on the drug).

[lostintime]

Well the educated and informed patient would want a MD doctor. However, I'm worried for patients who may not have the chocie or not understand all this political business, especially if NP's start calling themselves "doctors".

 

I think the biggest worry is that they themselves don't know their limits and are quick to be like "Oh you don't need a referral" and miss something in the meantime or the opposite, refer way too much and waste healthcare dollars. People think that being a GP is all easy because all you see are colds and you refer people when stuff gets tough, but the real difficulty is having the knowledge base to DISTINGUISH b/w the non-urgent and urgent/red-flags. It is NOT a simple algorithm or else a monkey could do it. Even though uptodate has guidelines, that's exactly what they are--- GUIDELINES not an actual algorithm for how to run a practice. Knowledge and critical thinking skills on how to actually differentiate b/w the benign and urgent takes a vast amount of knowledge and training.

 

So why should someone who was NEVER trained to diagnose, i.e. NP's, be allowed to diagnose? I heard that the NP program is very competitive, so I'm not saying that quality, intelligence, and work ethics of the people coming out of the program are exactly inferior. However, the training of the program is NOT the same as that of the family physician, so why are we allowing shortcuts in the system?

[mrnursing]

So why should someone who was NEVER trained to diagnose, i.e. NP's, be allowed to diagnose? I heard that the NP program is very competitive, so I'm not saying that quality, intelligence, and work ethics of the people coming out of the program are exactly inferior. However, the training of the program is NOT the same as that of the family physician, so why are we allowing shortcuts in the system?

 

While I understand that NPs are definitely not trained and educated as much as a physician (not even close), NPs are still taught and trained to diagnose, assess, and prescribe. They also know their limitations and scope of practice.

 

I've been diagnosed and treated by NPs, and I've felt pretty safe and my health and wellness was maintained.

 

Scope of practice:

http://www.cno.org/docs/prac/41038_StrdRnec.pdf

http://npao.org/documents/rnec.pdf

 

Lab tests and drugs allowed to be prescribed:

http://www.cno.org/docs/prac/062007_Rneclablist.html#drugs

 

mrnursing, can you give me a rundown of what the education is like for advanced nursing degrees? I'm starting to wonder if people want to see MDs as the people who hunt zebras, and have nurses being the ones doing primary care.

 

I can't recall what exactly they took, but I think it's been like 2 pharma course, 2 patho, diagnosis, assessment, and clinical in Canada.

[mildoc1]

So....the drs at your office defraud OHIP? That's great. No sarcasm here, nope none at all....

 

NPs in Canada are prepared at a Masters level, so I doubt if they'll be called doctors anytime soon. Nor should they want to be.

I think all the negative comments being posted about nurses are extremely disrespectful. I for one got great grades in high school, and after some time in an intense science program at a well-known university, opted to enter a profession where I was guaranteed patient contact and a good salary (not 'cos I flunked out either ). Hospital nurses are at the pt's bedside 24/7 and will know the patients and their families better then you ever will. I hope those of you who are in medical school gain some appreciation of your colleagues. And most staff physicians at my facility ask the nursing staff their opinion of the med students who are applying for residencies there.

But seriously- enough with the profession bashing. There are poor examples in any health care field (Such as the GP hospitalist who prescribed T3s to the pt with the codeine allergy...which was found out by a nurse...after the drugs had been dispensed by a pharmacist). NPs are a reality in our health care system, as are other mid-level practitioners.

[Mandibular]

wow, this really is ridiculous. As much as I agree that what nurses do is essential, and that they should get compensated more (what they do really is hard), they don't have the training to do what doctors do. also, I find it extremely insulting to GPs, who went through rigorous training, and are having their jobs given away to other people. A shortage of labour is not a valid reason to give certain privileges to none trained people.