Nurse Practitioner

[Gloria741]

Hello everyone,

 

I posted the same question last night, but it seems like the thread was deleted (i donno why, if anyone knows, kindly let me know), so I am reposting this question.

 

I have just recently accquired a profession called nurse practitioner. They are Registered Nurses with an extra a year to two of training. With the additional training, they are allowed to perform similar duties as doctors: consulting patients, diagnosing, prescribing medication etc w/o the supervision of a physician. From what I gather from the Ontario website, nurse practitioners are basically family doctors. And from what I heard from a friend, nurse practitioners can earn more than doctors. However, I do not know anyone who is a nurse practioner or has been dealing with them. Hence, I am asking people who know more about NP to explain the cons n pros of the profession a little more. What exactly is the difference between nurse practitioners and doctors? How is the job prospect of nurse practitioner? Is it difficult to be one?

 

http://www.healthforceontario.ca/WhatIsHFO/FAQs/NursePractitioners.aspx

 

Thanks a lot in advance

[mangoarecool]

Hello everyone,

 

I posted the same question from last night, but it seems like the thread was deleted (i donno why, if anyone knows, kindly let me know), so I am reposting this question.

 

I have just recently accquired a profession called nurse practitioner. They are Registered Nurses with an extra a year to two of training. With the additional training, they are allowed to perform similar duties as doctors: consulting patients, diagnosing, prescribing medication etc w/o the supervision of a physician. From what I gather from the Ontario website, nurse practitioners are basically family doctors. And from what I heard from a friend, nurse practitioners can earn more than doctors. However, I do not know anyone who is a nurse practioner or has been dealing with them. Hence, I am asking people who know more about NP to explain the cons n pros of the profession a little more. What exactly is the difference between nurse practitioners and doctors? How is the job prospect of nurse practitioner? Is it difficult to be one?

 

http://www.healthforceontario.ca/WhatIsHFO/FAQs/NursePractitioners.aspx

 

Thanks a lot in advance

 

First of all nurse practitioners are NOT like physicians. They are advanced nurses who can perform more procedures and have the ability to diagnose some illnesses.

 

Lets clarify a a few things, in a major city or urban center you will not find a nurse practitioner working at a capacity of a family physician, you will only find them in northern towns where no FP wants to go. In cities nurse practitioner usually works as specialists in wound care or respiratory care, they very rarely will prescribe any medications or come up with a diagnosis without consulting a physician.

 

Its a pretty decent job though you are making 100K and have more autonomy then a RN. To become one you need to finish a 4 year nursing degree, then work for 2 years in a ICU/Emerg setting. Then you apply to a masters Nurse practitioner program which takes an additional 2 years.

 

Make sure your charge nurse actually likes you or she won't write you a reference letter to apply to the program.

[kpm]

Lets clarify a a few things, in a major city or urban center you will not find a nurse practitioner working at a capacity of a family physician, you will only find them in northern towns where no FP wants to go.

 

Actually, this is not true. I volunteer at Toronto Western Hospital in the Family Medicine clinic, and there is an NP who is essentially a family doctor.

[MarieJJib]

many people are unware of the current roles NPs play in Ontario.

 

NPs function as a primary health care provider. You can now choose to see either an MD or NP in most cases, they essentially have the same authority and ability in terms of diagnosis and prescribing in their specialized areas.

 

There are many NP lead family clinics and they also work in hospitals...they do not work under the supervision of a physician (this is the case for a physician-assistant). There are four NP specialty certificates....NP-Primary Health Care, NP-Pediatrics, NP-Adult and NP-Anesthesia.

 

after 4 years you receive you BscN, you work for 2 years and apply to your Masters of Nursing (2 years), then take a 1 year program for your NP certificate.

[maritimer]

Hi there!

 

I can't speak much of for a comparison between NPs and Physicans, but I can provide you with a link of the differences between NP and PAs:

 

http://umanitoba.ca/faculties/medicine/media/A_COMPARISON_OF_PA__NP_May_2012_(2).pdf

[Msclphrnc]

An NP or family physician might be in a better position to comment on this topic. I don't fully understand this because there are many regulations involved. For example, in Ontario most medical procedures fall under 14 categories of "controlled acts":

 

1) physicians are authorized to perform 13 of these

2) NPs are authorized to perform 7 of these

(For comparison: RNs can perform 3 of these, and only with permission from a supervisor higher up)

 

But it's more complicated because these controlled acts don't include everything.

In terms of freedom, NPs (in Ontario) are not legally required to consult with physicians, but some employers still require this.

In terms of NP pay though, I'm pretty sure it's less than a family physician's on average (~100k vs 200k).

 

Certainly, an NP's scope of practice is less than a family physician's, but how much less? I'm not sure. You really have to ask an NP + MD who has worked with each other. And remember, this is just in Ontario. Every place has a different regulation.

[jerkstore]

An NP or family physician might be in a better position to comment on this topic. I don't fully understand this because there are many regulations involved. For example, in Ontario most medical procedures fall under 14 categories of "controlled acts":

 

1) physicians are authorized to perform 13 of these

2) NPs are authorized to perform 7 of these

(For comparison: RNs can perform 3 of these, and only with permission from a supervisor higher up)

 

But it's more complicated because these controlled acts don't include everything.

In terms of freedom, NPs (in Ontario) are not legally required to consult with physicians, but some employers still require this.

In terms of NP pay though, I'm pretty sure it's less than a family physician's on average (~100k vs 200k).

 

Certainly, an NP's scope of practice is less than a family physician's, but how much less? I'm not sure. You really have to ask an NP + MD who has worked with each other. And remember, this is just in Ontario. Every place has a different regulation.

 

Do you mean a FAMILY physician is allowed to perform 13 of 14, or just any physician? If it's the latter what's the one they're not allowed to do?!

 

edit: never mind I looked it up, dental-stuff. Why isn't dentistry just a medical specialty?

[Msclphrnc]

Do you mean a FAMILY physician is allowed to perform 13 of 14, or just any physician?

Both.

A family physician is allowed to perform those 13 acts, and the same applies for every other physician, regardless of specialty.

[leijona88]

 

after 4 years you receive you BscN, you work for 2 years and apply to your Masters of Nursing (2 years), then take a 1 year program for your NP certificate.

 

At Lakehead you can do a combined MPH (specialization in nursing) with NP which takes 2 years. Or NP cert without the MPH is one year as far as I've heard (graduated nursing at LU and pretty sure this is the case).

 

In reference to prior posts about wages, I know a couple NPs who work in community and what they tell me is you can make similar money to a family doc, because NPs usually work in a clinic or health centre where they don't have the overhead of the lease, secretary, hydro, etc that a family physician would have. But I have also heard newly graduated NPs say that being an NP your workload is similar to a physician but with less pay. An NP quoted to me that the difference between RN and NP pay is $4 per hour. She said not to do it for the money. These NPs told me to go to med school if I can get in lol. They work in a hospital though, so maybe NPs in community make more? in general I don't think you're gonna hit 6 digits. But wage-happiness are only positively correlated up to 60K a year, then flat-lines so as RN or NP we're good

[futureGP]

Actually, this is not true. I volunteer at Toronto Western Hospital in the Family Medicine clinic, and there is an NP who is essentially a family doctor.

 

i'm sure NPs look like they're doing similar things (run a clinic, see some simple bread/butter cases)

 

but it is true that NPs are limited in what they can do from either education or legislature.

 

It is a form of nursing where you're given a great deal of autonomy, but that said if you really want a full-out autonomy with no one telling you what to do and having all the abilities to do what you want (or the potential) in terms of procedures, diagnosis, treatment -- just go to med school and don't deal with the part turf-war, politics, and patient perspectives that go along with being an NP.

[leijona88]

 

It is a form of nursing where you're given a great deal of autonomy, but that said if you really want a full-out autonomy with no one telling you what to do and having all the abilities to do what you want (or the potential) in terms of procedures, diagnosis, treatment -- just go to med school and don't deal with the part turf-war, politics, and patient perspectives that go along with being an NP.

 

What do you mean by pt perspectives?

[futureGP]

What do you mean by pt perspectives?

 

it goes both ways.

 

some patients think NPs are great because they look at you as a whole (not that MDs don't) and take longer time with you (idk if that's true.. i've heard they don't actually do that... when I saw an NP for by TST, she didn't even say anything to me lol.. but yeah anyways)

 

some patients think they might as well see a 'real doc' (not that NPs are not competent) than a nurse, you know?

 

the public doesn't know much about nurse practitioners so if you're in the field you might be in a position where you need to advocate for yourself, whereas if you're an MD, people know what you can do etc

[leijona88]

it goes both ways.

 

some patients think NPs are great because they look at you as a whole (not that MDs don't) and take longer time with you (idk if that's true.. i've heard they don't actually do that... when I saw an NP for by TST, she didn't even say anything to me lol.. but yeah anyways)

 

some patients think they might as well see a 'real doc' (not that NPs are not competent) than a nurse, you know?

 

the public doesn't know much about nurse practitioners so if you're in the field you might be in a position where you need to advocate for yourself, whereas if you're an MD, people know what you can do etc

 

Gotcha. I've never been to an NP myself. They are on salary though rather than fee-for-service so I would assume they would be less inclined to rush through a visit.. A guy I play hockey with mentioned that he started going to an NP-led clinic, I asked what he thought of having an NP for a primary care provider, his reply "she's very nice." lol, didn't have much else to say about it. But I guess for a lay person it's pretty tough to tell whether a HCP is competent or not in most cases. But yeah it is a very new profession so it'll be interesting to see where it goes.

[jerkstore]

Were MD's ever on salary instead of pay per service?

[Louisarlen]

Hello!

There is no much difference between a physician and a nurse practitioner. Both are responsible for diagnosing diseases. Sometimes, NPs do as much as 80%to 90% of the work that physicians do. In some cases, they act equivalent to physicians. The years that physicians put in studying is more but, before becoming an NP, a candidate is already a trained RN. Both a specialized professionals in their own duties.

NPs care for patients in all aspects of their lives. Physician and NP care and knowledge overlaps and is complementary, but each has a core expertise that is distinct and unique. NPs make ideal primary care providers because of their holistic and wellness orientation that emphasizes health education, risk identification and reduction, and preventive care through lifestyle modification.

[hexonu]

Our scope of practice is similar to a physician's. There are some things we can't do like prescribing narcotics. We do things like setting broken bones, suturing, writing medical directives etc.

 

It's possible for an NP to make more than a physician but pretty rare considering an NP maxes out at 130k.

 

I don't know of a program that will accept you with 2 years experience, the norm is 3 years minimum (+ high grades) in an acute setting (ER, ICU, MED/SURG), a Psych nurse or OR nurse cannot become an NP.

 

 

Goodluck

[mursing]

Our scope of practice is similar to a physician's. There are some things we can't do like prescribing narcotics. We do things like setting broken bones, suturing, writing medical directives etc.

 

It's possible for an NP to make more than a physician but pretty rare considering an NP maxes out at 130k.

 

I don't know of a program that will accept you with 2 years experience, the norm is 3 years minimum (+ high grades) in an acute setting (ER, ICU, MED/SURG), a Psych nurse or OR nurse cannot become an NP.

 

 

Goodluck

 

I've seen many people get accepted to the NP program in Ontario with 2 years of experience.

 

They apply during after 1st year of working and get accepted by the time they finish their 2nd year.

[mursing]

Our scope of practice is similar to a physician's. There are some things we can't do like prescribing narcotics. We do things like setting broken bones, suturing, writing medical directives etc.

 

Isn't it scary how NP's scope of practice is similar to a physician's?

 

Here is Ontario Primary Health Care NP curriculum. It's only one year.

 

I left out the Master's courses as they don't relate to NP at all. Sure, you can apply to NP masters, but master's portion of it is just regular nursing masters.

 

http://np-education.ca/?page_id=13349

 

1. Pathophysiology for the Nurse Practitioner – September to April

Description: To examine the concepts of pathophysiology which guide the practice of advanced nursing practice. To study pathophysiolocial changes in individuals in a primary health care setting by taking into account their age, acuity, chronicity, and evolution of the conditions.

 

2. Roles and Responsibilities – September to April

Description: Compare and contrast advanced practice nursing and related frameworks to develop, integrate, sustain, and evaluate the role of the nurse practitioner within primary health care. Critically analyze and develop strategies to implement advanced practice nursing competencies with a focus on the community.

 

3. Advanced Health Assessment and Diagnosis I – September to December

Description: Analyze and critique concepts and frameworks essential to advanced health assessment and diagnosis using clinical reasoning skills. Apply clinical, theoretical and research knowledge in comprehensive and focused health assessment for the individual client’s diagnostic plan of care.

 

4. Advanced Health Assessment and Diagnosis II – January to April

Description: Integrate knowledge and apply conceptual frameworks integral to advanced health assessment and diagnosis in advanced nursing practice. Demonstrate initiative, responsibility, and accountability in complex decision making for individuals, groups, and/or families within the nurse practitioner scope of practice based on current research findings.

 

5. Therapeutics in Primary Health Care I – September to December

Description: Critically appraise and interpret concepts and frameworks integral to pharmacotherapy, advanced counselling, and complementary therapies for common conditions across the lifespan. Develop, initiate, manage, and evaluate therapeutic plans of care that incorporate client values and acceptability, goals of therapy, analysis of different approaches, pharmacotherapeutic principles.

 

6. Therapeutics in Primary Health Care II – January to April

Description: Integrate conceptual frameworks and evidence underlying the study of pharmacotherapy, advanced counselling, and complementary therapies for complex client situations. Demonstrate substantive initiative, responsibility, and accountability in complex decision making.

 

7. Integrative Practicum – May to August

Description: Synthesize the competencies essential to advanced nursing practice to provide primary health care for clients across the life span. Demonstrate autonomy, decision-making, and critical analysis of organizational and system issues that influence scope of practice, professional accountability, and outcomes.

Clinical: 5 full days/week for 12 weeks for a total of 416 hours

 

This is crazy. How is anyone suppose to practice medicine properly with this kind of education?

 

That's why I never considered doing the NP program.

[A-Stark]

Clinical: 5 full days/week for 12 weeks for a total of 416 hours

 

Considering I routinely worked over 80 hours a week during clerkship, this amounts to a couple of weeks of fairly limited training without any call. That's not to say NP students don't learn a lot during that training, but it's pretty limited in scope and length.

 

This is crazy. How is anyone suppose to practice medicine properly with this kind of education?

 

They don't. Most of them - all I've worked with - also realize this and do not stray outside their comfort zone. Unfortunately, this also means that they consult a lot more and function "autonomously" only in the sense that they can write orders and scripts. This is fine for routine primary care or even routine post-op care, but the moment things go slightly off the rails, they consult and generally don't handle anything acute very well.

 

We hear repeatedly in the media how physicians should be "freed up" of doing "routine" things. While just about anyone can be trained to do a simple procedure, only time and depth and breadth of training provides adequate experience for sound clinical decision making. That's how you figure out the "routine" from the "complicated" and make appropriate decisions about both.

[mursing]

Considering I routinely worked over 80 hours a week during clerkship, this amounts to a couple of weeks of fairly limited training without any call. That's not to say NP students don't learn a lot during that training, but it's pretty limited in scope and length.

 

They don't. Most of them - all I've worked with - also realize this and do not stray outside their comfort zone. Unfortunately, this also means that they consult a lot more and function "autonomously" only in the sense that they can write orders and scripts. This is fine for routine primary care or even routine post-op care, but the moment things go slightly off the rails, they consult and generally don't handle anything acute very well.

 

We hear repeatedly in the media how physicians should be "freed up" of doing "routine" things. While just about anyone can be trained to do a simple procedure, only time and depth and breadth of training provides adequate experience for sound clinical decision making. That's how you figure out the "routine" from the "complicated" and make appropriate decisions about both.

 

I did work with some very competent NPs, but they had at least a decade of experience working as a NP.

 

I just wouldn't fully trust a decision made by a newly graduated NP.

[NLengr]

Considering I routinely worked over 80 hours a week during clerkship, this amounts to a couple of weeks of fairly limited training without any call. That's not to say NP students don't learn a lot during that training, but it's pretty limited in scope and length.

 

 

 

They don't. Most of them - all I've worked with - also realize this and do not stray outside their comfort zone. Unfortunately, this also means that they consult a lot more and function "autonomously" only in the sense that they can write orders and scripts. This is fine for routine primary care or even routine post-op care, but the moment things go slightly off the rails, they consult and generally don't handle anything acute very well.

 

We hear repeatedly in the media how physicians should be "freed up" of doing "routine" things. While just about anyone can be trained to do a simple procedure, only time and depth and breadth of training provides adequate experience for sound clinical decision making. That's how you figure out the "routine" from the "complicated" and make appropriate decisions about both.

 

As one Gen Surgeon at my center like to say: Procedures are only simple or routine after they are completed.

[concernedmedstudent]

When I hear of NPs and PAs saying they are the same it makes me realize how much knowledge they in fact lack. Those who believe this clearly do not even know enough about medicine to recognize how much they do not know. The smart NPs and PAs are excellent but they are also the ones the recognize how different their training is and what there very important roles and responsibilities are.

 

Much respect to these excellent NPs and Pas for being important members of the healthcare team and improving the quality of care for patients. I feel bad for you that you have some embarrassing colleagues that don't even know what they don't know and create this strange tension between physicians and advanced nurses.

[hexonu]

Considering I routinely worked over 80 hours a week during clerkship, this amounts to a couple of weeks of fairly limited training without any call. That's not to say NP students don't learn a lot during that training, but it's pretty limited in scope and length.

 

 

 

They don't. Most of them - all I've worked with - also realize this and do not stray outside their comfort zone. Unfortunately, this also means that they consult a lot more and function "autonomously" only in the sense that they can write orders and scripts. This is fine for routine primary care or even routine post-op care, but the moment things go slightly off the rails, they consult and generally don't handle anything acute very well.

 

We hear repeatedly in the media how physicians should be "freed up" of doing "routine" things. While just about anyone can be trained to do a simple procedure, only time and depth and breadth of training provides adequate experience for sound clinical decision making. That's how you figure out the "routine" from the "complicated" and make appropriate decisions about both.

 

Not sure why but you seem to have a vendetta against NPs, lol. A nurse practitioner who specializes in family medicine isn't going to have the same skill set as one who spent three years working in the ICU and is comfortable with acute cases. Also, since when did consulting become a bad thing? Physicians consult all the time when something is out of their scope, but when an NP does it somehow is deemed as "lacks training".

 

I'll admit though that the NP program does need some refining, and by that I mean mandating more science classes in lieu of "nursing fluff". However, nursing is life long learning and during my career whenever I didn't understand something (for the sake of my patients) about a case or a drug I was administering I would ask the physicians to explain, and most of the time they would be more than happy. It didn't stop there I also took many certifications and did studying on my own. In this sense most of what I'm learning now is an affirmation of my prior experience as an RN.

 

For the NPs that seem inept, that's a fault of the entire system as a whole, and again I suggest a revamp of the entire program.

 

For the most part I think we all work together pretty well, except for that med student who has no idea what the scope of a NP is, but i'll save that for another thread.

 

/rant

[A-Stark]

Not sure why but you seem to have a vendetta against NPs, lol. A nurse practitioner who specializes in family medicine isn't going to have the same skill set as one who spent three years working in the ICU and is comfortable with acute cases. Also, since when did consulting become a bad thing? Physicians consult all the time when something is out of their scope, but when an NP does it somehow is deemed as "lacks training".

 

It's kind of a bad thing and absolutely happens too much. But in fairness that is *hardly* specific to NPs, and we are guilty of it from time to time. In this specific example, I was harping on NPs who do nothing but manage post-op CV surgery floor and stepdown patients who routinely consult cardiology about routine post-op CV surgery issues.

 

Anyway, at my centre the neurology floor definitely could use an NP to manage the ALC and less active patients, as well as provide a continuous presence rather than a revolving door of housestaff.

[concernedmedstudent]

It's kind of a bad thing and absolutely happens too much. But in fairness that is *hardly* specific to NPs, and we are guilty of it from time to time. In this specific example, I was harping on NPs who do nothing but manage post-op CV surgery floor and stepdown patients who routinely consult cardiology about routine post-op CV surgery issues.

 

Anyway, at my centre the neurology floor definitely could use an NP to manage the ALC and less active patients, as well as provide a continuous presence rather than a revolving door of housestaff.

 

NP's are a VERY expensive way to deliver care. Much in the same way that mid-wives are far more expensive than GPs on a per delivery case.

 

There are some interesting studies in Canada that have been published regarding the efficacy of NPs.

 

Many NPs are paid upwards of $110 000/yr + benefits + pension without doing ANY CALL. In the studies where they had a relatively independent practice, they would see about 1/3 as many patients as a GP and refer and order unecessary investigations much more often. When they crunched the numbers it actually cost almost twice as much per patient to have an NP than an MD. So much for cost savings..