Nurses acting like physicians

[aaronjw]

actually at my school, you'll get kicked out if you have an average of c.

 

just sayin

 

not before they give you lots of opportunities and help first.

[jerkoutnow2]

What do you call an doctor who graduated with C's?. A doctor. No one is trying to get nurses to replace doctors, We're all fallible regardless of how long we went to school for. Suggesting that NPs can treat minor and routine medical issues is not a stretch at all.

 

M.D. = 4 years undergrad + 4 years medical school + 2/3 years residency

NP = 4 years undergrad +3 years graduate school + 2 years work experience

 

again, very simplified approach to see this

 

4-years of med school cannot possibly equal 3 years of NP grad school that doesn't even put primary focus on medicine

 

+ 2 years of work experience does not equal 2-years of residency. Residents aren't just working, they work lots over time, actively continue reading/learning etc

 

you can't compare MDs with NPs just by looking at training.

 

this is what american DNP programs are trying to do - by lengthening the program they're trying to 'legitimize' their eligibility to practise medicine because they have the same 'length of training' as MDs do.

[jerkoutnow2]

oh and it's quite funny

 

how so many students entering accelerated nursing programs do because they want to be NPs cuz they think they can practically do the same work as a family MD (and legally speaking they will, cuz the ON liberal government will give them that)

 

i get that there is a shortage of Family MDs but NPs aren't really helping solve that shortage anyways, many of them (probably the same proportion of them as compared to family MDs) stay and practise in the cities (search up NP clinic in toronto) where it already is saturated

 

so what is the real purpose? -- greed, greed by CNA who are sick and tired of working as nurses and want to become something beyond a nurse

 

don't get me wrong, if you plan on being an NP and work in cities with shortage of family MDs, lots of respect to you

 

but that's not what the data shows

[leviathan]

What do you call an doctor who graduated with C's?. A doctor. No one is trying to get nurses to replace doctors, We're all fallible regardless of how long we went to school for. Suggesting that NPs can treat minor and routine medical issues is not a stretch at all.

 

M.D. = 4 years undergrad + 4 years medical school + 2/3 years residency

NP = 4 years undergrad +3 years graduate school + 2 years work experience

Forget about the undergrad stuff and let's focus on the actual length of solid medical training:

Family MD = 4 years medical school + 2 years residency

Family NP = 3 years nurse practitioner

 

Nursing school is not medical school, so I wouldn't include that. There's only a few medical courses in nursing school like physio and path, and I've taken them. They were merely a fraction of what was taught in medical school.

 

Also, work experience does not count for medical education, because you're working as a nurse, doing nursing assessments and administering medications for the most part. You're not rounding on patients getting daily teaching from attendings, working 60-80 hours/week (or more), diagnosing, forming a differential, making treatment plans, reading after hours to study for boards etc.

[concernedmedstudent]

Forget about the undergrad stuff and let's focus on the actual length of solid medical training:

Family MD = 4 years medical school + 2 years residency

Family NP = 3 years nurse practitioner

 

Nursing school is not medical school, so I wouldn't include that. There's only a few medical courses in nursing school like physio and path, and I've taken them. They were merely a fraction of what was taught in medical school.

 

Also, work experience does not count for medical education, because you're working as a nurse, doing nursing assessments and administering medications for the most part. You're not rounding on patients getting daily teaching from attendings, working 60-80 hours/week (or more), diagnosing, forming a differential, making treatment plans, reading after hours to study for boards etc.

 

 

Pretending that NP and MD students are equal when they begin their training (they are not - MD students come from the top HS students who go to the top Universities who then are at the top of their University class vs nurse practitioners who are generally middle of the road in HS, middle of the road in an avg university or college and then the top of their nursing school class)... but pretending they are equal the length of training is even more different than it appears by just comparing number of years.

 

Lets assume a 40 hour work week for 12 months per year to equal one year of education.

 

Now I don't know that much about NP school but I'd be shocked if (given all the union restrictions etc) that very much of the training exceeds 40 hours a week.

 

Now lets just compare a GPs training to an NP

 

Nursing school 3x40hrs/week + NP school 2x 40hrs/wk =5 "standard" years.

 

Medical school: 2 years at 40hrs/wk (primarily preclinical) + 2 hrs averaging 60 hrs/wk(clinical) + 2 years 70hrs/wk (Residency) = 8.5 "standard" years of training.

 

 

In addition to this - the amount of responsibility, rigour and the expectations of medical training are vastly different between the two programs.

 

How many code blues do NPs (or CRNAs for that matter) run as the most responsible person prior to graduation?

 

How many surgical procedures have they performed?

 

How often have NPs been called in the middle of the night to figure out why a patient is acutely decompensating and be loaded with the responsibility of leading a team of healthcare workers?

 

 

Its apples and oranges.

[concernedmedstudent]

See attached

[Robin Hood]

See attached[ATTACH]556[/ATTACH]

 

What's top tier in Canada? Plus in the US, there are many MD programs in low-tier schools?

[hexonu]

Pretending that NP and MD students are equal when they begin their training (they are not - MD students come from the top HS students who go to the top Universities who then are at the top of their University class vs nurse practitioners who are generally middle of the road in HS, middle of the road in an avg university or college and then the top of their nursing school class)... but pretending they are equal the length of training is even more different than it appears by just comparing number of years.

 

Lets assume a 40 hour work week for 12 months per year to equal one year of education.

 

Now I don't know that much about NP school but I'd be shocked if (given all the union restrictions etc) that very much of the training exceeds 40 hours a week.

 

Now lets just compare a GPs training to an NP

 

Nursing school 3x40hrs/week + NP school 2x 40hrs/wk =5 "standard" years.

 

Medical school: 2 years at 40hrs/wk (primarily preclinical) + 2 hrs averaging 60 hrs/wk(clinical) + 2 years 70hrs/wk (Residency) = 8.5 "standard" years of training.

 

 

In addition to this - the amount of responsibility, rigour and the expectations of medical training are vastly different between the two programs.

 

How many code blues do NPs (or CRNAs for that matter) run as the most responsible person prior to graduation?

 

How many surgical procedures have they performed?

 

How often have NPs been called in the middle of the night to figure out why a patient is acutely decompensating and be loaded with the responsibility of leading a team of healthcare workers?

 

 

Its apples and oranges.

 

Typing from my phone so excuse any mistakes.

 

Once again, i'll reiterate that I'm not saying a GP and NP are both fully equal, they're very similar. An NP is NOT fully trained under the medical model they use a biopsychosocial model to treat patients. So they are NOT equal. Yes I'm implying that medicine is not the only route to address health concerns, even though NPs make use of medical interventions. In short NPs pratice much more holistically than a GP. I know this is anecdotal but every GP I've been to had no passion and went through the motions to see more patients. An NP considers all aspects of an individual. Not saying all GPs are bad but there are notable differences.

 

 

Also to get into nursing you have to be top of your class 80% average at least in high school to be specific. I think in Manitoba you need atleast a 3.5,3.9 in some cases (https://umanitoba.ca/faculties/nursing/prospective/undergrad/entrance_4year.html) I wouldn't consider that mid level. Some are admitted to medical school with much less.

 

You say that you know little about what happens in NP school so not sure what gives you the insight to talk about it in such detail.

 

As an EM RN I run codes all the time since I have ACLS. who do you think is with the patient 90% of the time? Even more so in LTC.

 

I think this is just ignorance on your part to see what nursing school actually entails. The program I finished was theory/labs in the fall and 3 month clinicals labs in the winter, every year for four years. Sure we may not learn advance patho etc but do we really need that? As an APN you'll take those classes and have to do clinicals in every rotation.

 

Obviously, the Ontario government acknowledges the safe and efficient care NPs provide and its worked successfully in the form of NP led PC clinics. NP is not a new profession its only come into the media recently as a result of our PC shortage.

[A-Stark]

Once again, i'll reiterate that I'm not saying a GP and NP are both fully equal, they're very similar. An NP is NOT fully trained under the medical model they use a biopsychosocial model to treat patients. So they are NOT equal. Yes I'm implying that medicine is not the only route to address health concerns, even though NPs make use of medical interventions. In short NPs pratice much more holistically than a GP. I know this is anecdotal but every GP I've been to had no passion and went through the motions to see more patients. An NP considers all aspects of an individual. Not saying all GPs are bad but there are notable differences.

 

I think this is nonsense and little more than the usual "nursing theory" fluff that gets passed off to make things seem more different than they are. Physicians don't get taught some sort of "medical model" that specifically eschews looking at "all aspects" of an individual, and I disagree that NPs offer any kind of alternate paradigm to address health concerns.

 

NPs certainly practice differently than physicians in many contexts, but this usually has more to do with the type of practice than anything else. Some who I've worked with in acute care do the exact same job as housestaff, only without call or participation in an academic program. Primary care isn't much different - usually similar work with somewhat lower volume.

 

And there tend to be big gaps in NP knowledge in acute or surgical management. Only 6 months into clerkship I'd delivered babies, did I&Ds in various places, drilled burr holes, sutured skin and galea, looked at dozens and dozens of CXRs, CTs, ultrasounds in the clinical context, and seen patients in emerg, more than 10 different clinics, implying complete histories and exams that, frankly, are well beyond what RNs get trained to do.

 

One practising (and otherwise great) NP I worked with had scarcely done a single DRE. This has nothing to do with one "model" or another but with the adequacy of training and experience to address health concerns through appropriate histories, examinations, investigations, and management plans, up to and including certain invasive interventions.

 

(And if you want to find physicians who always consider the "whole individual", you should spend time with some geriatricians.)

[futureGP]

what is the nursing model?

[CapillaryWave]

Also to get into nursing you have to be top of your class 80% average at least in high school to be specific. I think in Manitoba you need atleast a 3.5-3.9 in some cases. I wouldn't consider that mid level. Some are admitted to medical school with much less.

 

I graduated high school with around an 80%, it was no where near the top of the class. I also graduated undergraduate with approximately a 3.8, and it was on the low end when compared to my fellow medical students.. I'd refer to myself and anyone else with those averages as near the bottom, not the top.

[concernedmedstudent]

I graduated high school with around an 80%, it was no where near the top of the class. I also graduated undergraduate with approximately a 3.8, and it was on the low end when compared to my fellow medical students.. I'd refer to myself and anyone else with those averages as near the bottom, not the top.

 

Those are sold scores and you are right they would put you near the bottom of a medical school class and near the top of a nursing class. The thing a lot of NPs just don't understand is how truly competitive the MD side of things are. They also sometimes think that there 4.0 from a community college makes them on par or better than someone with a 3.8 from a UToronto Engineering program. ITs more than numbers and unless you've gone through it is hard to understand the differences. Unfortunately there is no easy way to explain these differences without sounding like an arrogant a$$.

 

CapWave - MD/PhD maybe you are able to explain it

[NutritionRunner]

It's been quite a number of years since registered nurses graduated from community college. Currently, you need to graduate from university in order to become a registered nurse (although there are collaborative programs that involve both a university and a college, that reward undergraduate degrees in nursing).

 

So nurses, nowadays, definitely go through four years of university study, at a minimum, not just community college.

[Orcamute]

Why not just be a Male Nurse? We are severely lacking them.

[concernedmedstudent]

It's been quite a number of years since registered nurses graduated from community college. Currently, you need to graduate from university in order to become a registered nurse (although there are collaborative programs that involve both a university and a college, that reward undergraduate degrees in nursing).

 

So nurses, nowadays, definitely go through four years of university study, at a minimum, not just community college.

 

In Vancouver nursing programs are predominantly run through community colleges: Quantlan, BCIT, Douglas College etc. UBC does have a nursing program but it is by no means supplies the majority of nurses.

 

With regards to pre requisites - that is also a huge mix - while indeed many more nurses do have University Degrees I would definitely not say it is the majority - many have college certificates or college degrees prior to nursing. Maybe BC is different from others?

[NutritionRunner]

In Vancouver nursing programs are predominantly run through community colleges: Quantlan, BCIT, Douglas College etc. UBC does have a nursing program but it is by no means supplies the majority of nurses.

 

With regards to pre requisites - that is also a huge mix - while indeed many more nurses do have University Degrees I would definitely not say it is the majority - many have college certificates or college degrees prior to nursing. Maybe BC is different from others?

 

Are they registered nurses or are they practical nurses?

In Ontario, registered nurses absolutely have to have a university degree. Again, there are some combined programs with colleges, where the students study at a college and at a university, but they graduate with university degrees. Practical nurses have college diplomas, but they can't write the practice exams for registered nursing, and they certainly can't become NPs.

 

For Ontario, you can see here that nurses need a baccalaureate degree in nursing:

http://www.cno.org/en/become-a-nurse/about-registration/types-of-registration/general-class/

(and lower down on that page you see the RPNs have college diplomas, but they are NOT RNs)

[A-Stark]

It's debatable whether RNs really need to have a university degree. In any case - even in Ontario - students can take BScN programs at community colleges, though their degrees may be officially granted from a nearby university.

[concernedmedstudent]

Are they registered nurses or are they practical nurses?

In Ontario, registered nurses absolutely have to have a university degree. Again, there are some combined programs with colleges, where the students study at a college and at a university, but they graduate with university degrees. Practical nurses have college diplomas, but they can't write the practice exams for registered nursing, and they certainly can't become NPs.

 

For Ontario, you can see here that nurses need a baccalaureate degree in nursing:

http://www.cno.org/en/become-a-nurse/about-registration/types-of-registration/general-class/

(and lower down on that page you see the RPNs have college diplomas, but they are NOT RNs)

 

Are you talking about having University degrees prior to entering a nursing program or a Nursing Degree?

[CapillaryWave]

Those are sold scores and you are right they would put you near the bottom of a medical school class and near the top of a nursing class. The thing a lot of NPs just don't understand is how truly competitive the MD side of things are. They also sometimes think that there 4.0 from a community college makes them on par or better than someone with a 3.8 from a UToronto Engineering program. ITs more than numbers and unless you've gone through it is hard to understand the differences. Unfortunately there is no easy way to explain these differences without sounding like an arrogant a$$.

 

CapWave - MD/PhD maybe you are able to explain it

 

Haha, well maybe!

 

The majority of my friends throughout university were BN students, and are now RNs, so I'm quite familiar with their educational background and training. I recall them taking a full-course of anatomy & physiology and pathopharmacology. Additionally, they took courses like statistics and nutrition, but the majority of their courses were in nursing theory. They also started clinical and practicum placements at the end of first year, and never had a "typical" course load again (more like weekly/monthly seminars, papers, and tests), with additional tests on their practical nursing skills (taking manual blood pressure, giving IVs, etc). My friends were always busy with something, and often worked as undergraduate nurses, research assistants, or nursing aides in their free time.. I could easily have a good conversation with any them about general medical topics (i.e. Aneurysms), but they don't have an advanced working knowledge of them (i.e. Popliteal venous aneurysm vs. dissecting aneurysm).

 

Our educations had truly next to nothing in common.. To put it simply, everything they learned about (patho)physiology and pharmacology in their entire degree, I learned in a single semester of undergraduate. Is that a bad thing? Of course not. But we were worlds apart, and if one of them decided to become an NP, I'd wonder whether they learned more about medicine than I did in undergraduate, none the less what I've learned as a doctoral/medical student...

[concernedmedstudent]

I think one of the biggest differences is that nurses know what to do but not necessarily why they are doing it.

 

A basic example:

 

Most RNs will know to give ventolin to an asthmatic who has increased WOB, and sounds wheezy - but they don't really know why. Most can't explain to you about Beta 2 vs Beta 1 agonism vs alpha etc. They just know how to give the ventolin as directed. They probably couldn't explain the difference between giving nebulized epi vs salbutamol. (I realize this is a generalization and maybe some could but in general its just not a priority for them).

 

Another good example is diabetic ketoacidosis - they know to be careful and slowly give fluids but they can't tell you much about osmole shedding and WHY these kids are particularly susceptible to cerebral edema.

 

One of the biggest issues is that MDs do much of this thinking in their heads and make their orders accordingly without ever explaining it to their nursing colleagues. For this reason nurses often think that it is as simple as memorizing certain medications for certain clinical situations.

 

This is especially true of the nurse anaesthetists in the States - they think they are "the same as anesthesiologists" because they are able to give the same drugs at similar doses and produce similar effects. What they don't understand is why and how each of these drugs are affecting their patients - and it is for this reason that when things get complicated they wind up being up sh$t creek without a paddle.

[A-Stark]

I don't really like getting into these discussions because it inevitably makes me seem hostile to RNs. I'm not. They play an immense, inextricable, and utterly central role in the health care system in pretty much every context, and they tend to have excellent judgement when it comes to triaging patients and, especially, knowing when something is wrong. We are a team and that's the way it will always be.

 

However, I also feel that RNs who advocate for increased "scope" of practice, up to and including more autonomy for NPs, represent a dangerous trend, because they simply do not know what they don't know. Even as a med student it was obvious to me that they were "worlds apart" (apologies to CapillaryWave). There seems to be a lack of appreciation for the nature of the medical team, and far too much reliance on questionable nursing theory fluff that suggests there is some alternative "paradigm" that makes up for the lack of basic medical knowledge.

 

It doesn't. Not for one second.

[A-Stark]

Another good example is diabetic ketoacidosis - they know to be careful and slowly give fluids but they can't tell you much about osmole shedding and WHY these kids are particularly susceptible to cerebral edema.

 

A related example occurred on my first clerkship block when my friend had to explain to the PICU nurse that hyperkalemia in DKA was the result of the acidosis and would be improved with insulin.

 

This is especially true of the nurse anaesthetists in the States - they think they are "the same as anesthesiologists" because they are able to give the same drugs at similar doses and produce similar effects. What they don't understand is why and how each of these drugs are affecting their patients - and it is for this reason that when things get complicated they wind up being up sh$t creek without a paddle.

 

On my second day of my first anesthesia rotation, my staff spent much of the day talking about the variable quality of training in the US, to the point that low quality programs there had allowed for the growth of CRNAs.

 

I suppose anesthesiology is superficially similar to nursing practice since it involves fiddling with IVs, monitors, and pushing IV drugs and fluids. Of course, at one time physicians had to do most of that, and even had to take their own labs.

[CapillaryWave]

I don't really like getting into these discussions because it inevitably makes me seem hostile to RNs. I'm not. They play an immense, inextricable, and utterly central role in the health care system in pretty much every context, and they tend to have excellent judgement when it comes to triaging patients and, especially, knowing when something is wrong. We are a team and that's the way it will always be.

 

However, I also feel that RNs who advocate for increased "scope" of practice, up to and including more autonomy for NPs, represent a dangerous trend, because they simply do not know what they don't know. Even as a med student it was obvious to me that they were "worlds apart" (apologies to CapillaryWave). There seems to be a lack of appreciation for the nature of the medical team, and far too much reliance on questionable nursing theory fluff that suggests there is some alternative "paradigm" that makes up for the lack of basic medical knowledge.

 

It doesn't. Not for one second.

 

Agreed. I have a great amount of respect for RNs, and no need to apologize.

[concernedmedstudent]

I don't really like getting into these discussions because it inevitably makes me seem hostile to RNs. I'm not. They play an immense, inextricable, and utterly central role in the health care system in pretty much every context, and they tend to have excellent judgement when it comes to triaging patients and, especially, knowing when something is wrong. We are a team and that's the way it will always be.

 

However, I also feel that RNs who advocate for increased "scope" of practice, up to and including more autonomy for NPs, represent a dangerous trend, because they simply do not know what they don't know. Even as a med student it was obvious to me that they were "worlds apart" (apologies to CapillaryWave). There seems to be a lack of appreciation for the nature of the medical team, and far too much reliance on questionable nursing theory fluff that suggests there is some alternative "paradigm" that makes up for the lack of basic medical knowledge.

 

It doesn't. Not for one second.

 

I agree 100% - Well said.

 

I think the best people to speak to the differences are the many wonderful talented RNs that wanted more autonomy and scope and thus decided to go to medical school and residency to gain that autonomy, scope and most importantly responsibility. They will then be able to speak to the vast differences in training and knowledge.

 

I personally know a few nurses that have done this - a few that were found it extremely challenging and were successful, and a few that thought it would be pretty easy and eventually realized how much they didn't know and decided to go back to the extremely important role of nursing.

 

I have the utmost respect for nurses - they are an extremely important part of the team, but they play a very different role than the MD.

[NutritionRunner]

Are you talking about having University degrees prior to entering a nursing program or a Nursing Degree?

 

Nursing degree. Registered nurses in Ontario have to have a bachelor's degree (in nursing) in order to be able to write the exam to become a registered nurse.

 

Note that this is different from RPNs. RPNs go to college and obtain a diploma that allows them to write the exam for RPNs.

 

RPNs and RNs are NOT the same. RPNs currently do a lot of the work that "nurses" used to do, back when "nursing" was a college program. In Ontario, currently, in order to become a registered nurse (and only registered nurses can apply to become NPs after the required years of experience) you NEED to have an undergraduate degree in NURSING. Just check out the link I posted earlier. It clearly outlines what you need to be an RN (registered nurse) and that it differs from an RPN. The RN absolutely requires a nursing DEGREE.