Perspectives on NPs at CNN

I agree with the already posted responses, although, I do not feel that the EMT, medical resident or the PA are best able to address the comments because their jobs/roles are different.

I say this because of the RN experience I have had over the past 19 years. EMT's come from a 'field' perspective; medical residents are still learning the 'ropes' and often are reminded of things by nurses and other physicians experienced in a specific area and PA's are trained under the medical model alone at varied degree levels (which include associate, bachelor's and master's degrees).

Working as a nursing faculty and ANP, I see two main issues: 1) many physicians (although not all) see NP's as additional monetary supplements to existing practices. Patient satisfaction is high related to NP care (according to several research articles) but the physicians would rather continue 'incident to' billing to reap the 100% reimbursement rather than allow NP's to be counted for the care they provide. I disagree with this and find it VERY unfortunate. 2) It is not only NP's who could make a misdiagnosis, physician's do this as well, nobody is perfect. I believe we all do our best to give the appropriate care to patients. Physicians discuss difficult or uncertain diagnoses/presentations amongst each other just as NP's discuss the same MD's. I believe that is what is in the best interest of patients and 'bouncing' ideas/concerns from one colleague to another just improves that patient's care. Again, no one can know everything.

Finally, I believe that most NP's have a 'workable' relationship with the physicians they work with but I find it extremely unfortunate that the physicians that responded in the CNN article had mainly negative comments about NP's as a whole. No statistical or already studied research trials regarding patient care/satisfaction/diagnosis or follow up, etc., was provided (all of which has been studied and shown positive and equal care among NP’s and physicians); and the NP's were categorized in with some PA's (some likely with only associate degrees; although not clearly defined in the comments). Most NP's have a minimum of greater than 10-15 years of RN experience in ICU/ER settings prior to attending NP schooling which is currently at the Master's level.

As for NP's referring to specialists over-abundantly and taking too much time discussing patient issues with collaborating physicians, I disagree. It may be more noted in younger/less experienced NP's but those who are seasoned typically do not require un-needed consultation from the collaborating MD or referrals. Again, it would be more accurate and solid of an argument had statistics been provided.

It would be ALL of our hopes (I would think) that we (physician's, NP's, PA's, etc.) could respect and honor each of our own levels of education, experiences and knowledge levels without so much bickering over 'who's the best person to care for this patient'.

If we are all truly in the field to provide the best care for the patient, we should be able to work together!

I just wanted to clear up one thing. Nurse practitioners are independently licensed to provide care under a well defined scope of practice. As nurse practitioners, we work collaboratively with physicians and many other members of the health care team.

If we are negligent or contribute in any way to malpractice, we assume full and independent responsibility for our practice, our care decisions, and our license. To say that we "do not take any legal liability for [our] decisions" is inaccurate.

I have worked in practices where the collaborating physician is on-site and others which are, for simplicities sake, mostly owned and operated by nurse practitioners. It is a gross overstatement to say that all physicians are opposed to NPs/PAs functioning in the primary care role. In fact, it has been my experience that most physicians appreciate the role that NPs/PAs are able to play in our modern, expensive, and complicated system. Certainly with the declining number of medical students choosing primary care and the rising need for care providers in these areas it seems counter productive to argue over the territory.

I hope we can continue to work together to develop a system that provides quality care to everyone who needs it.

Beautifully said, Sharon C.!

I do not make as much as a family practice physician.

I own the practice so as a small business owner things are alot different than in large practices.  I have the responsibility to oversee the business and make sure everyone gets paid before I do. My choice.

I have found many "zebras" when the patients have been told all they need is an antidepressant because of all their somatic complaints.  To say that we might miss "rare" disorders may be true but MD's are not exempt from this either.  

The Holistic nursing (or.too, medical) approach of  - mind, body, spirit - with prevention, education, early detection and on going support is what people crave.

A little personal attention goes a long way to encourage compliance.   Honoring the patient as a total human being with individual rights is the first one of the patient's bill of rights.  How often are people treated as just a disease waiting to be "fixed"!!

My ego does not prevent me from seeking expert advice from specialists, as I know my scope of practice.

I work well with MD's, DO and naturopathic physicians, etc in a collaborative role, when necessary, with those providers who accept my position and credibility.  No one knows everything.

As we go forward with whatever health reform the government comes up with, we need to work together and always remember to keep what is best for the patient and what the patient needs in the forefront of our minds.  Let's be done with the turf wars!!

Peaceful, spiritually centered, devoted providers who have a passion for what they do will always be in demand.

Namaste,

Sharon C.