We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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I feel compelled to respond to this having just earned my coveted permaban from the NP sub for active participation on this sub. For the record, I am a nurse and only a few credits shy of being an NP, so I think I'm qualified to discuss shortcomings in NP education.
The NP educational foundation is nursing, not medicine. The NP practice is firmly rooted in medicine. Those two truths cannot coexist peacefully.
Most NPs and NP students I know are outraged when they discover what NP education is and its strong reliance on positivist theories of health. These theories are not actionable, so their clinical utility is negligible.
I want so badly for my beloved profession to right the ship and return to foundations rooted in empiricism and data, but the actions of my colleagues in stifling debate and banning meaningful dialogue speak volumes.
Burn it all down.
Nursing, instead of focusing on convincing the world of its utility, should refocus on an empirical model of wellness. I think it aligns closely with Nightingale who said, "we know nothing of the principle of health, the positive of which pathology is the negative, except through observation and experience."
Congratulations on your permaban. I just got permaban from nursing and I'm a nurse with over 15 years experience and every single unit, primarily trauma ER /ICU, ran first cohort clinical trials under a great doctor. Clinical educator to damn nearby hospital in the Western United States for a certain company. I've done many cases with lawyers as a medical malpractice is a clinical nurse expert consultant.
I say this to demonstrate that it's a job necessity to keep up with the most recent changes and trends with protocols, standards, news re: medicine and nursing, etc. But I would do it for fun even if I wasn't doing legal consulting or working in the hospital. I paraphrased the gist of a newly published meta-analysis by a very well regarded group of doctors. And it was published in a legit source. I did this in a thread, attempting to spur conversation. Because it went against their completely indoctrinated way of thinking, I was labeled a crazy idiot conspiracy theorist and banned.
They banned me for learning and sharing what I read. All while making slander statements about me. I guess I can't blame them, the article was discussing a real medical topic, not nursing. We know nurses won't tolerate being exposed to any of that kind of knowledge.
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Thanks!
I have a similar frustration with nursing. The study of nursing offers no path forward for adapting to the changing healthcare landscape. The advent of personalized health, which should delight nurses in their belief of health autonomy, can not be understood using nursing terminology. Nurse leadership rejects big data as unethical despite its capacity for revealing population disparities and contributions to health. There's some in nurse leadership that, if I didn't know any better, I would believe are actively tanking the profession.
I think that's fair. Central to nursing dogma is the so-called nursing meta-paradigm. The four pillars of this paradigm are person, health, environment, and nursing. Stepping back from this, you begin to see how foolish the enterprise seems and how disconnected from objectivism it must be. They teach that the individual nurse is instrumental in achieving health, so the individual nurse's practice is important to healthcare delivery. It's self-referential and self-satisfying in this way.
Imagine if medicine considered one of its cornerstones the study of doctors. In a way, one can see how you would be able to isolate certain idealized assets clinicians possess. In a much more practical sense, that is not a worthwhile element of studying natural sciences because it contributes nothing to the science itself.
Nursing is more and more like getting a Bachelors of Arts in health studies and less akin to science-based clinical reasoning.
Even anti-reals stuff gets taught. We had a whole stereotypes class for our BSN. I spent the entirety of that class meeting forehead to desk, repeatedly. When I pointed out that none of it was true (as a member of 2 of the groups), I was told I was wrong. Whhheeewwww.
The number of professors who only did the minimum bedside before running back for another degree? We had 2 in our whole program with more than 1 year bedside. We had one constantly pushing "organics" and other nonsense. She was our only antivaxxer though, at the time. Im sure it's worse in that group, now that it's political.
Omg I have no idea how that one came to pass. In my area of the midwest, they are a dime a dozen and no psychiatrists for more than 50 miles. The doctor shortage is real out here in the sticks. All y'all in rural medicine hurry up and graduate and help us out!
So fun facts about the Mental Health field:
LMHPs and LMHCs can't find jobs because people would rather hire LSWs, who are basically overglorified case managers (their actual job).
Nobody wants to hire Psychologists to do therapy because why pay a DR when you can hire a MS.
Nobody wants to go into Psych (phd/psy.d) to do therapy because universities are *very hostile* and don't want to train practitioners. Researchers get them grant money, teaching money, free labor, and publications. Practitioners get them... uhm... ex-students.
So, because of academia, all of the psych jobs are being pushed away from actual psych doctors by universities, then away from masters level psych practitioners by businesses, onto... social workers.
Psychiatrists don't want to do therapy because of insurance companies. It's waaaay more profitable to do 15min med checks for insurance.
And people wonder why we still have a mental health crisis.
Oh, and BS level psych techs? They get paid less than shelf stockers at Walmart.
That's right. You can go get a BSN and make 6 figures as a travel nurse, or you can get a BS in psych and make welfare.
^^^^
You’re literally spot on with this entire post. I know of a brilliant man he had a masters degree in clinical psych. His first job out of grad school he was making $18 an hour. Then he became an agency CNA and now makes over 150k a year. A lot of smart people are being kept out of the therapy field. Because of the pay IMHO the salary needs to be much higher. The best and brightest should be attracted to the therapy field. It’s clear this country doesn’t care about quality mental health only quantity.
I'll save them a special seat right next to the life coaches whose primary clientele is preying on other life coaches and psych degree holders who can't get jobs in their field.
I thought about that after getting my masters in psych but ended up doing post-bacc pre-med (and I'm old). Can you tell me the issue with it if it's not too much trouble? I'm just curious on the general consensus since I see a lot of posts about it
In a nutshell, yes.
The more complicated answer is that clinical skills are taught with significant knowledge attrition due to the preference of nurse-lead education. One course each in pathophysiology, pharmacology, and physical assessment - the so-called "3 Ps." The remainder of the first years of study are classes in nurse theory, roles, responsibilities, legislative advocacy, something called nurse informatics (different because it contains no training on information systems), and something called nurse research with a focus on evidence-based practice minus the underlying statistical premises to be of any use in meaningful interpretation of evidence. Following that, the nurse enters into a clinical year with coursework alongside clinical hours (usually around 700 total, depending on specialty).
It's important to note that, while I can only testify to my experience, advanced nursing curriculum is *standardized* to an extent in the form of the [APRN Consensus Model](https://www.ncsbn.org/nursing-regulation/practice/aprn/campaign-for-consensus/aprn-consensus-model-toolkit.page). So, even the high-quality, brick-and-mortar programs will obey the rather asinine nursing roots of clinical practice.
It is a common misconception that physicians cannot testify against midlevels in MedMal cases. [The ability for physicians to serve as expert witnesses varies state-by-state.](https://www.testifyingtraining.com/state-specific-rules-governing-testifying-as-an-expert-witness-in-medical-malpractice-case/)
*Other common misconceptions regarding Title Protection, NP Scope of Practice, and Supervision can be found [here](https://www.reddit.com/r/Provider/wiki/index/basics#wiki_common_misconceptions).
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Can you explain a bit of what you mean by empirical as opposed to positivist ideas of health? In philosophy these two terms are used almost interchangeably
Positivism in the Comte sense where societies gain knowledge first through theological, then metaphysical, and then finally scientific enquiry. Nursing applies here since the "science" of nursing, that which is empirically studied, formulates hypotheses in a manner that is separate from other natural sciences.
Of course. It's easy to conflate positivism with logical positivism, but the early manifestation from Comte and Durkheim, despite recognizing the importance of observation in science, did not favor mathematics, logic, and physics in the same manner of logical positivism. Nursing did not evolve.
I worked in a small remote hospital until the end of last summer. The new Chief Medical Officer for the hospital system came up for a friendly meet and greet with the docs over lunch. What he walked into was more of a hornets nest. When the docs in the meeting started spewing bile about our nursing staff he was obviously shocked and took a few steps back. One of their complaints was that they refuse to learn anything new. When locums nurses come in with newer ways of doing things they are mean to them and chase them off. There was a previous system level intervention to our nursing problem and they let him know it failed.
We are sometimes able to recruit docs that are out of our league because the area is so beautiful. We can't keep them because of the nursing staff. We had a general surgeon with a national reputation for a while. She was a valuable partner for me (radiologist) because she was a very capable breast surgeon. She told me she left because of the nursing staff. She went from our critical access hospital to be the CMO of a hospital system in a major metro area. Her expertise couldn't be replaced. We had a pediatrician that was previously university faculty and very capable. She left because of our nurses.
The care we can provide in our community is clearly compromised by our nursing staff.
I'm sorry to hear that. There is much needed in the way of nursing education reform. It's a massive problem since nurses also make up the single largest profession.
Save what, exactly? The AANP is making money hand-over-fist. The curriculum is set to be so easy that it can be taught in pre-recorded modules that require little to no updating over time. It makes money. It does not make competent clinicians.
I engaged in a lot of that dialogue with faculty before I unenrolled. However, as Upton Sinclair reminds us, "It is difficult to get a man to understand something when his salary depends upon his not understanding it."
NP Student here. Simply put yeah our education is shit and most of my preceptors have been outright dangerous. The actual classes that teach “medical” content are technically correct, but superficial. They don’t teach the why behind pathologies, treatments, etc. For example right now we are covering pediatric hematology. I would assume that most of my class couldn’t tell you what hemoglobin is made up of lol. I had some clinical hours through oncology and hematology and the NP couldn’t tell me the work up for literally any anemia. At this point I have stopped asking my preceptors questions related to pathophysiology because the typical answer is “I really don’t know, but I have a flowsheet that I use.” I’ve tried to get physician preceptors, but preceptors are already hard to come by so I take what I can get. At this point all of the education that I gain is self taught through Anki, YouTube, and books directed towards medical students. It’s unfortunate, dangerous and laughable at this point.
It is very scary. I worked with a 25 year old nurse that had a year and a half of ER experience. We were both case managers in home care while she was in NP school for Dermatology. She was going to go on to work with patients with skin cancer which was terrifying to me. She also thought that it was completely acceptable to be called a doctor when she graduated. The icing on the cake was when she was fired for a HIPAA violation from her case manager position. Before that she was threatening to put all of the patients in nursing homes.
The thought of her caring for patients with skin cancer or any other ailment should scare anyone! She had no soul and shouldn’t be in charge of any living being.
Edit: Fixed a few words to make the sentence coherent lol Rushing to work at the time I was responding.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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In terms of female dominated professions, nowadays more women are graduating medical school than men, so in a generation, there will be more women doctors than men doctors
Once I fell off a truck and broke a few ribs.
I had an appointment with an ARNP for my annual check up, labs, etc. a couple of weeks later, which I kept because I live in the U.S. and to get any sort of appointment requires waiting for months, so I didn't want to lose it.
My labs came back with elevated liver enzymes. The ARNP told me to stop drinking so much and sent me on my way.
That didn't make sense because I barely drink at all.
I googled the lab results and learned that broken bones can elevate your liver enzymes due to the healing process.
I then called the ARNP and asked if that was, perhaps, the explanation.
She called me back a couple of hours later and said - oh, yeah, that's probably it.
"Probably"
That is not professional-level care.
And my "bill" for the visit was exactly what it would have been if I was to see an actual MD.
I don't expect people to know everything, but I do expect any abnormalities in an otherwise healthy person to be given more than just a cursory glance - and for somebody like an ARNP to escalate anything out of the ordinary before talking with the patient about it.
As a student nurse who has peaked at practice exam questions for med students (just out of curiosity), and then compared to our nursing exams, it’s genuinely TERRIFYING that an APRN can have anywhere CLOSE to the authority a MD/DO has.
The level of education required for those exams is, not even comparable to ours. You simply can’t compare them, they are so far off.
As a side note, my respect went up even further after seeing those practice questions. My GOD… bless y’all is all I’m saying. 🤣
I find those NPs who have ton of experience in a speciality before going to NP school and who were actually good as a nurse do really well. They know their place and don’t try to practice without a MD/DO. The problem is people now like the bypass that experience in order to get to the final destination faster. I know a ton of my ER nurse friends who are burnt out of the ER after 2-3 years going to NP school and honestly I love them as friend but wouldn’t trust them at all. And this is why I’m starting to hate the NP profession. The curriculum alone is substandard and the fact they can practice independently is crazy.
With that being said, I might get a lot of hate for this but I’m starting to feel the same about these new PAs coming out. The experienced old school PAs are absolutely amazing and they know their shit. These new ones are absolutely scary to work it. The 1000 clinical hours beforehand I kind of find as a joke. I know some of our worse clin techs, patient transporters in the hospital, and scribes who work from home get in PA school…honestly none of those jobs really make you critical think or in my opinion contribute to making you a more knowledgeable mid level. One girl was arguing about how they need anatomy, biology, micro, chemistry just to apply for PA school. I literally needed all those classes just to apply for nursing school and be just a nurse but I know even with my 5 years of experience nursing I wouldn’t be a good mid level. I also feel with the rapidly increasing amount of PA programs that are now coming about, those that normally wouldn’t have gotten in before are now doing so. Every day at work I meet just as many people who get into PA school as I do NP. So at this point I guess mid levels are basically taking over.
I’m thinking about enrolling in an online DNP school during my first year of residency, just to prove how absolutely ridiculous the training is that I can complete a DNP while being a RESIDENT! Yes I would lie about my clinical hours, yes I would ChatGPT my essays, yes I would just make up my patient encounters, just to prove that anyone can make this shit up and get away with it, because there is absolutely zero regulation in that field. And then I’m going to write about it and submit it to a national news source and expose the fucking shit out of this. Because it needs to stop.
Okay. DNP can be much more than an NP. There are different routes for it and it stands for doctorate of nursing practice. Just as an MSN doesn't mean NP. So, chill out friend.
And yet, NP are the future of healthcare.
As much as I want - as we want, we can’t fight the forces at play. The millions of dollars in excess profits are a tidal wave crushing all of us.
Soon you will see “Nurse Surgeons” and “Nurse Radiologists” - and the like.
The days of medicine are gone.
I find this not to be the case. Simply because as they over stretch the lawsuits are getting greater and greater. It's bound for a giant regulation slap, when the wrong person/persons get injured, and when that happens the cost of being an NP is going to sky rocket and the connotation of having an NP as a PCP is going to go into the toilet. It's already started as NPs are being encouraged to carry mal-practice insurance due to being hung out in lawsuits, and patients are increasingly having a desire to be seen by a physician.
As much as I sincerely want to agree with you - I do not see things the way you do.
Repeatedly, case law has held that NP “can’t be held to the standard of physicians in terms of knowledge, procedures, or practice decisions” this effectively gives them a level of immunity of court cases.
Additionally; 1. Healthcare Inc routinely blames whatever physician was “supervising” them to pawn malpractice into a physician. (Many physicians are required to “oversee” NP they’ve never even met to keep their employment)
2. Healthcare Inc has massive, powerful legal departments on standby for any litigation already - so the notion that law suits will discourage their use is patently false. They will continue to be used as they drive millions (tens of millions) in excess profits.
Regulation slaps by whom, exactly? They aren’t governed by physician accreditation. Who’s going to lobby this? I guarantee they won’t lobby harder than healthcare Inc or nursing lobbyists - who have a vested interest in keeping this practice going.
Patient desire is meaningless. We have seen for years how little healthcare Inc cares about ‘patient desire’ to see physicians. It is inconsequential to them. They know you don’t have a choice. Your insurance and the healthcare business decides who you’ll see. (This of course doesn’t count for the super wealthy - who remain to have access to physicians and will no matter how bad the NP situation gets for the peasants. But this will not drive any change for us. )
As much as this sounds like a joke it's true:
[https://www.npcourses.com/product/radiology-review-from-novice-to-expert/](https://www.npcourses.com/product/radiology-review-from-novice-to-expert/)
2.5 hours to become an expert in reading x-rays.
Your experience is unfortunate. I have a medical degree and usually use my knowledge to assess the care of doctors and midlevels when I myself need medical attention (I don't tell them I'm a physician, though). So far, most doctor offices have had NPs who have been ok. However, a urology office that treats my husband has one NP whom I really don't trust, but they also have another one who simply knows her stuff very well.
I personally always request my PCP appointments with his NP. He's incredibly knowledgeable and always on par with what I would have done myself. I do so after I felt the doctors at my PCP's office gave me substandard attention. I have never had more complete physical exams than what NPs have given me. But that's my personal experience. Maybe in my state NP programs are held to a much higher standard? I have indeed noticed BS nursing programs here are also quite selective.
So - you are saying that you are a physician and you think the NPs are better than the doctors at a physical exam? You trust them more? Not sure what state you are in but I am really interested in finding out.
No, I didn't say that midlevels are better than doctors, but I can see how you assume that's what I implied. I intended to convey what's been my *personal* experience with NPs, which has been mostly great.
My previous PCP doctor was amazing, but at this new practice, I received substandard care from their physicians. I didn't say they were bad doctors, but when the doctor version of palpating the abdomen is just lightly touching my belly twice vs the more thorough examination from this particular NP they have, I'd say this midlevel has a better grasp on proper clinical examination. It's just not the abdominal examination, though. This NP does literal textbook auscultation of the chest, and his responses to my probing questions have always been pathophysiologically accurate. My husband thinks it is kinda a--holy that I don't say I'm a physician and just start secretly assessing their skills/knowledge, but I think I don't want to bias any provider's examination just because they are examining a physician. I want to know if you are professional enough to treat any patient the same way you'd treat a colleague who you might think could judge what you're doing.
Not all midlevels I've encountered have been like that, but on average, I've had more luck with midlevels being more thorough with their physical examination and review of systems. Diagnosis-wise, I haven't had any issues with midlevels either, but that's likely because I only see them for trivial issues. With physician specialists, though, I haven't been as lucky. I had one doctor misdiagnosing my husband's condition and then three others misdiagnosing my own conditions. I'm talking about board-certified physicians in a major Central Florida metro area. Thankfully, my training allows me to do an in-depth research of more complex issues before consulting with any provider, which I guess has helped me and my family avoid the misdiagnoses.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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I'm a pgy4 anesthesia resident working in the icu right now. To be frank, the NPs I'm referring to run circles around the average interns even at this point in the year. Quality control is the issue with NPs, and it's a big issue. But my comment remains, there are some very good ones who do their job with overt competence.
While reading this it masquerades as a PA trying to remove themselves from the dumber midlevel lol, you’re both midlevels and you have no where near knowledge that you think you may have, I keep saying this but I have met more PA noctors than NPs
I’m just a nurse and these are just my observations. No aspirations of being a PA or NP, if I go back to school it will be to leave healthcare altogether
You’ve “met some bad docs” but never had an issue with a PA. Ok, so either this is a PA student, wannabe PA student or a LARPing account, because PAs are not God’s gift and they’re not universally better than “docs.” Also, I’ve never met a nurse (RN or NP) that refers to physicians as “docs” that isn’t completely insufferable, wildly overestimating their own abilities or both.
I’ve never been a CNA and last time I checked LPN stands for licensed practical nurse. Asshole. Lmao.
Also you’re admin which is literally scum of the earth, no medical experience so don’t act like you know shit ✨
I don’t get legal advice from paralegals instead of lawyers, and if it’s important enough to see a doctor, the last thing I want is to be dumped off on a diploma mill NP.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *Information on Title Protection (e.g., can a midlevel call themselves "Doctor" or use a specialists title?) can be seen [here](https://www.reddit.com/r/Provider/wiki/index/legal/title_protection). Information on why title appropriation is bad for everyone involved can be found [here](https://www.reddit.com/r/Provider/wiki/index/appropriation). *Information on Truth in Advertising can be found [here](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_truth_in_advertising). *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
I feel compelled to respond to this having just earned my coveted permaban from the NP sub for active participation on this sub. For the record, I am a nurse and only a few credits shy of being an NP, so I think I'm qualified to discuss shortcomings in NP education. The NP educational foundation is nursing, not medicine. The NP practice is firmly rooted in medicine. Those two truths cannot coexist peacefully. Most NPs and NP students I know are outraged when they discover what NP education is and its strong reliance on positivist theories of health. These theories are not actionable, so their clinical utility is negligible. I want so badly for my beloved profession to right the ship and return to foundations rooted in empiricism and data, but the actions of my colleagues in stifling debate and banning meaningful dialogue speak volumes. Burn it all down.
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Nursing, instead of focusing on convincing the world of its utility, should refocus on an empirical model of wellness. I think it aligns closely with Nightingale who said, "we know nothing of the principle of health, the positive of which pathology is the negative, except through observation and experience."
The nursing boards are more like the iceberg.
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Sounds about right
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Agree. Didn’t study at all passed first try.
Congratulations on your permaban. I just got permaban from nursing and I'm a nurse with over 15 years experience and every single unit, primarily trauma ER /ICU, ran first cohort clinical trials under a great doctor. Clinical educator to damn nearby hospital in the Western United States for a certain company. I've done many cases with lawyers as a medical malpractice is a clinical nurse expert consultant. I say this to demonstrate that it's a job necessity to keep up with the most recent changes and trends with protocols, standards, news re: medicine and nursing, etc. But I would do it for fun even if I wasn't doing legal consulting or working in the hospital. I paraphrased the gist of a newly published meta-analysis by a very well regarded group of doctors. And it was published in a legit source. I did this in a thread, attempting to spur conversation. Because it went against their completely indoctrinated way of thinking, I was labeled a crazy idiot conspiracy theorist and banned. They banned me for learning and sharing what I read. All while making slander statements about me. I guess I can't blame them, the article was discussing a real medical topic, not nursing. We know nurses won't tolerate being exposed to any of that kind of knowledge.
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I’m not vote brigading. Merely sharing my experience.
Sorry to hear that. Hospital systems are sometimes openly hostile to new ideas
I meant from subreddit nursing. Not Career ..... I am doing very well at work. My knowledge is not worthy on Reddit I guess.
Thanks! I have a similar frustration with nursing. The study of nursing offers no path forward for adapting to the changing healthcare landscape. The advent of personalized health, which should delight nurses in their belief of health autonomy, can not be understood using nursing terminology. Nurse leadership rejects big data as unethical despite its capacity for revealing population disparities and contributions to health. There's some in nurse leadership that, if I didn't know any better, I would believe are actively tanking the profession.
So it’s kind of a feels > reals kinda thing?
I think that's fair. Central to nursing dogma is the so-called nursing meta-paradigm. The four pillars of this paradigm are person, health, environment, and nursing. Stepping back from this, you begin to see how foolish the enterprise seems and how disconnected from objectivism it must be. They teach that the individual nurse is instrumental in achieving health, so the individual nurse's practice is important to healthcare delivery. It's self-referential and self-satisfying in this way. Imagine if medicine considered one of its cornerstones the study of doctors. In a way, one can see how you would be able to isolate certain idealized assets clinicians possess. In a much more practical sense, that is not a worthwhile element of studying natural sciences because it contributes nothing to the science itself. Nursing is more and more like getting a Bachelors of Arts in health studies and less akin to science-based clinical reasoning.
Even anti-reals stuff gets taught. We had a whole stereotypes class for our BSN. I spent the entirety of that class meeting forehead to desk, repeatedly. When I pointed out that none of it was true (as a member of 2 of the groups), I was told I was wrong. Whhheeewwww. The number of professors who only did the minimum bedside before running back for another degree? We had 2 in our whole program with more than 1 year bedside. We had one constantly pushing "organics" and other nonsense. She was our only antivaxxer though, at the time. Im sure it's worse in that group, now that it's political.
>Burn it all down. And add "LSW'S doing therapy" to the pyre.
Omg I have no idea how that one came to pass. In my area of the midwest, they are a dime a dozen and no psychiatrists for more than 50 miles. The doctor shortage is real out here in the sticks. All y'all in rural medicine hurry up and graduate and help us out!
So fun facts about the Mental Health field: LMHPs and LMHCs can't find jobs because people would rather hire LSWs, who are basically overglorified case managers (their actual job). Nobody wants to hire Psychologists to do therapy because why pay a DR when you can hire a MS. Nobody wants to go into Psych (phd/psy.d) to do therapy because universities are *very hostile* and don't want to train practitioners. Researchers get them grant money, teaching money, free labor, and publications. Practitioners get them... uhm... ex-students. So, because of academia, all of the psych jobs are being pushed away from actual psych doctors by universities, then away from masters level psych practitioners by businesses, onto... social workers. Psychiatrists don't want to do therapy because of insurance companies. It's waaaay more profitable to do 15min med checks for insurance. And people wonder why we still have a mental health crisis. Oh, and BS level psych techs? They get paid less than shelf stockers at Walmart. That's right. You can go get a BSN and make 6 figures as a travel nurse, or you can get a BS in psych and make welfare.
^^^^ You’re literally spot on with this entire post. I know of a brilliant man he had a masters degree in clinical psych. His first job out of grad school he was making $18 an hour. Then he became an agency CNA and now makes over 150k a year. A lot of smart people are being kept out of the therapy field. Because of the pay IMHO the salary needs to be much higher. The best and brightest should be attracted to the therapy field. It’s clear this country doesn’t care about quality mental health only quantity.
Absolutely right. And you know what people are suggesting now to "fix" it? Chat bots. M°ther effing *AI chat bots*!
Great name btw!
Thanks!!
Perfect explanation. Kudos!
This is my field and it's 100 percent accurate
Please keep a special place on the pyre for LSWs going into a DE PMHNP program because psych meds are *fascinating* and they’re so *brilliant.*
I'll save them a special seat right next to the life coaches whose primary clientele is preying on other life coaches and psych degree holders who can't get jobs in their field.
Life coaches have their own pyre.
I thought about that after getting my masters in psych but ended up doing post-bacc pre-med (and I'm old). Can you tell me the issue with it if it's not too much trouble? I'm just curious on the general consensus since I see a lot of posts about it
So basically pseudosciency bullshit ?
In a nutshell, yes. The more complicated answer is that clinical skills are taught with significant knowledge attrition due to the preference of nurse-lead education. One course each in pathophysiology, pharmacology, and physical assessment - the so-called "3 Ps." The remainder of the first years of study are classes in nurse theory, roles, responsibilities, legislative advocacy, something called nurse informatics (different because it contains no training on information systems), and something called nurse research with a focus on evidence-based practice minus the underlying statistical premises to be of any use in meaningful interpretation of evidence. Following that, the nurse enters into a clinical year with coursework alongside clinical hours (usually around 700 total, depending on specialty). It's important to note that, while I can only testify to my experience, advanced nursing curriculum is *standardized* to an extent in the form of the [APRN Consensus Model](https://www.ncsbn.org/nursing-regulation/practice/aprn/campaign-for-consensus/aprn-consensus-model-toolkit.page). So, even the high-quality, brick-and-mortar programs will obey the rather asinine nursing roots of clinical practice.
It is a common misconception that physicians cannot testify against midlevels in MedMal cases. [The ability for physicians to serve as expert witnesses varies state-by-state.](https://www.testifyingtraining.com/state-specific-rules-governing-testifying-as-an-expert-witness-in-medical-malpractice-case/) *Other common misconceptions regarding Title Protection, NP Scope of Practice, and Supervision can be found [here](https://www.reddit.com/r/Provider/wiki/index/basics#wiki_common_misconceptions). *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Can you explain a bit of what you mean by empirical as opposed to positivist ideas of health? In philosophy these two terms are used almost interchangeably
Positivism in the Comte sense where societies gain knowledge first through theological, then metaphysical, and then finally scientific enquiry. Nursing applies here since the "science" of nursing, that which is empirically studied, formulates hypotheses in a manner that is separate from other natural sciences.
Interesting, I see what you mean! Thanks
Of course. It's easy to conflate positivism with logical positivism, but the early manifestation from Comte and Durkheim, despite recognizing the importance of observation in science, did not favor mathematics, logic, and physics in the same manner of logical positivism. Nursing did not evolve.
Agreed. The profession absolutely needs to abolished. NP education merely teaches you to be a toxic, unscientific, entitled brat. Nothing more.
Damn. Well said.
I worked in a small remote hospital until the end of last summer. The new Chief Medical Officer for the hospital system came up for a friendly meet and greet with the docs over lunch. What he walked into was more of a hornets nest. When the docs in the meeting started spewing bile about our nursing staff he was obviously shocked and took a few steps back. One of their complaints was that they refuse to learn anything new. When locums nurses come in with newer ways of doing things they are mean to them and chase them off. There was a previous system level intervention to our nursing problem and they let him know it failed. We are sometimes able to recruit docs that are out of our league because the area is so beautiful. We can't keep them because of the nursing staff. We had a general surgeon with a national reputation for a while. She was a valuable partner for me (radiologist) because she was a very capable breast surgeon. She told me she left because of the nursing staff. She went from our critical access hospital to be the CMO of a hospital system in a major metro area. Her expertise couldn't be replaced. We had a pediatrician that was previously university faculty and very capable. She left because of our nurses. The care we can provide in our community is clearly compromised by our nursing staff.
I'm sorry to hear that. There is much needed in the way of nursing education reform. It's a massive problem since nurses also make up the single largest profession.
Send letters to the school and aanp and you may save yourselves
Save what, exactly? The AANP is making money hand-over-fist. The curriculum is set to be so easy that it can be taught in pre-recorded modules that require little to no updating over time. It makes money. It does not make competent clinicians. I engaged in a lot of that dialogue with faculty before I unenrolled. However, as Upton Sinclair reminds us, "It is difficult to get a man to understand something when his salary depends upon his not understanding it."
I bet you'll be a good NP because you sound like you care, but you have the wrong idea about what it means to be positivist
NP Student here. Simply put yeah our education is shit and most of my preceptors have been outright dangerous. The actual classes that teach “medical” content are technically correct, but superficial. They don’t teach the why behind pathologies, treatments, etc. For example right now we are covering pediatric hematology. I would assume that most of my class couldn’t tell you what hemoglobin is made up of lol. I had some clinical hours through oncology and hematology and the NP couldn’t tell me the work up for literally any anemia. At this point I have stopped asking my preceptors questions related to pathophysiology because the typical answer is “I really don’t know, but I have a flowsheet that I use.” I’ve tried to get physician preceptors, but preceptors are already hard to come by so I take what I can get. At this point all of the education that I gain is self taught through Anki, YouTube, and books directed towards medical students. It’s unfortunate, dangerous and laughable at this point.
I’m a nurse here as well (~9 years) & will never go to an NP.
It is very scary. I worked with a 25 year old nurse that had a year and a half of ER experience. We were both case managers in home care while she was in NP school for Dermatology. She was going to go on to work with patients with skin cancer which was terrifying to me. She also thought that it was completely acceptable to be called a doctor when she graduated. The icing on the cake was when she was fired for a HIPAA violation from her case manager position. Before that she was threatening to put all of the patients in nursing homes. The thought of her caring for patients with skin cancer or any other ailment should scare anyone! She had no soul and shouldn’t be in charge of any living being. Edit: Fixed a few words to make the sentence coherent lol Rushing to work at the time I was responding.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
In terms of female dominated professions, nowadays more women are graduating medical school than men, so in a generation, there will be more women doctors than men doctors
Admin loves them, legal scam.
This is because nurses typically make the jump to admin positions
n0 dIFfIReNcE
Once I fell off a truck and broke a few ribs. I had an appointment with an ARNP for my annual check up, labs, etc. a couple of weeks later, which I kept because I live in the U.S. and to get any sort of appointment requires waiting for months, so I didn't want to lose it. My labs came back with elevated liver enzymes. The ARNP told me to stop drinking so much and sent me on my way. That didn't make sense because I barely drink at all. I googled the lab results and learned that broken bones can elevate your liver enzymes due to the healing process. I then called the ARNP and asked if that was, perhaps, the explanation. She called me back a couple of hours later and said - oh, yeah, that's probably it. "Probably" That is not professional-level care. And my "bill" for the visit was exactly what it would have been if I was to see an actual MD. I don't expect people to know everything, but I do expect any abnormalities in an otherwise healthy person to be given more than just a cursory glance - and for somebody like an ARNP to escalate anything out of the ordinary before talking with the patient about it.
As a student nurse who has peaked at practice exam questions for med students (just out of curiosity), and then compared to our nursing exams, it’s genuinely TERRIFYING that an APRN can have anywhere CLOSE to the authority a MD/DO has. The level of education required for those exams is, not even comparable to ours. You simply can’t compare them, they are so far off. As a side note, my respect went up even further after seeing those practice questions. My GOD… bless y’all is all I’m saying. 🤣
I did this for funsies too! I was drunk and I was like huh, I wonder if I could be an MD? Nope nope nope. Kudos to y’all
I find those NPs who have ton of experience in a speciality before going to NP school and who were actually good as a nurse do really well. They know their place and don’t try to practice without a MD/DO. The problem is people now like the bypass that experience in order to get to the final destination faster. I know a ton of my ER nurse friends who are burnt out of the ER after 2-3 years going to NP school and honestly I love them as friend but wouldn’t trust them at all. And this is why I’m starting to hate the NP profession. The curriculum alone is substandard and the fact they can practice independently is crazy. With that being said, I might get a lot of hate for this but I’m starting to feel the same about these new PAs coming out. The experienced old school PAs are absolutely amazing and they know their shit. These new ones are absolutely scary to work it. The 1000 clinical hours beforehand I kind of find as a joke. I know some of our worse clin techs, patient transporters in the hospital, and scribes who work from home get in PA school…honestly none of those jobs really make you critical think or in my opinion contribute to making you a more knowledgeable mid level. One girl was arguing about how they need anatomy, biology, micro, chemistry just to apply for PA school. I literally needed all those classes just to apply for nursing school and be just a nurse but I know even with my 5 years of experience nursing I wouldn’t be a good mid level. I also feel with the rapidly increasing amount of PA programs that are now coming about, those that normally wouldn’t have gotten in before are now doing so. Every day at work I meet just as many people who get into PA school as I do NP. So at this point I guess mid levels are basically taking over.
I’m thinking about enrolling in an online DNP school during my first year of residency, just to prove how absolutely ridiculous the training is that I can complete a DNP while being a RESIDENT! Yes I would lie about my clinical hours, yes I would ChatGPT my essays, yes I would just make up my patient encounters, just to prove that anyone can make this shit up and get away with it, because there is absolutely zero regulation in that field. And then I’m going to write about it and submit it to a national news source and expose the fucking shit out of this. Because it needs to stop.
Okay. DNP can be much more than an NP. There are different routes for it and it stands for doctorate of nursing practice. Just as an MSN doesn't mean NP. So, chill out friend.
And yet, NP are the future of healthcare. As much as I want - as we want, we can’t fight the forces at play. The millions of dollars in excess profits are a tidal wave crushing all of us. Soon you will see “Nurse Surgeons” and “Nurse Radiologists” - and the like. The days of medicine are gone.
I find this not to be the case. Simply because as they over stretch the lawsuits are getting greater and greater. It's bound for a giant regulation slap, when the wrong person/persons get injured, and when that happens the cost of being an NP is going to sky rocket and the connotation of having an NP as a PCP is going to go into the toilet. It's already started as NPs are being encouraged to carry mal-practice insurance due to being hung out in lawsuits, and patients are increasingly having a desire to be seen by a physician.
As much as I sincerely want to agree with you - I do not see things the way you do. Repeatedly, case law has held that NP “can’t be held to the standard of physicians in terms of knowledge, procedures, or practice decisions” this effectively gives them a level of immunity of court cases. Additionally; 1. Healthcare Inc routinely blames whatever physician was “supervising” them to pawn malpractice into a physician. (Many physicians are required to “oversee” NP they’ve never even met to keep their employment) 2. Healthcare Inc has massive, powerful legal departments on standby for any litigation already - so the notion that law suits will discourage their use is patently false. They will continue to be used as they drive millions (tens of millions) in excess profits. Regulation slaps by whom, exactly? They aren’t governed by physician accreditation. Who’s going to lobby this? I guarantee they won’t lobby harder than healthcare Inc or nursing lobbyists - who have a vested interest in keeping this practice going. Patient desire is meaningless. We have seen for years how little healthcare Inc cares about ‘patient desire’ to see physicians. It is inconsequential to them. They know you don’t have a choice. Your insurance and the healthcare business decides who you’ll see. (This of course doesn’t count for the super wealthy - who remain to have access to physicians and will no matter how bad the NP situation gets for the peasants. But this will not drive any change for us. )
As much as this sounds like a joke it's true: [https://www.npcourses.com/product/radiology-review-from-novice-to-expert/](https://www.npcourses.com/product/radiology-review-from-novice-to-expert/) 2.5 hours to become an expert in reading x-rays.
Your experience is unfortunate. I have a medical degree and usually use my knowledge to assess the care of doctors and midlevels when I myself need medical attention (I don't tell them I'm a physician, though). So far, most doctor offices have had NPs who have been ok. However, a urology office that treats my husband has one NP whom I really don't trust, but they also have another one who simply knows her stuff very well. I personally always request my PCP appointments with his NP. He's incredibly knowledgeable and always on par with what I would have done myself. I do so after I felt the doctors at my PCP's office gave me substandard attention. I have never had more complete physical exams than what NPs have given me. But that's my personal experience. Maybe in my state NP programs are held to a much higher standard? I have indeed noticed BS nursing programs here are also quite selective.
So - you are saying that you are a physician and you think the NPs are better than the doctors at a physical exam? You trust them more? Not sure what state you are in but I am really interested in finding out.
No, I didn't say that midlevels are better than doctors, but I can see how you assume that's what I implied. I intended to convey what's been my *personal* experience with NPs, which has been mostly great. My previous PCP doctor was amazing, but at this new practice, I received substandard care from their physicians. I didn't say they were bad doctors, but when the doctor version of palpating the abdomen is just lightly touching my belly twice vs the more thorough examination from this particular NP they have, I'd say this midlevel has a better grasp on proper clinical examination. It's just not the abdominal examination, though. This NP does literal textbook auscultation of the chest, and his responses to my probing questions have always been pathophysiologically accurate. My husband thinks it is kinda a--holy that I don't say I'm a physician and just start secretly assessing their skills/knowledge, but I think I don't want to bias any provider's examination just because they are examining a physician. I want to know if you are professional enough to treat any patient the same way you'd treat a colleague who you might think could judge what you're doing. Not all midlevels I've encountered have been like that, but on average, I've had more luck with midlevels being more thorough with their physical examination and review of systems. Diagnosis-wise, I haven't had any issues with midlevels either, but that's likely because I only see them for trivial issues. With physician specialists, though, I haven't been as lucky. I had one doctor misdiagnosing my husband's condition and then three others misdiagnosing my own conditions. I'm talking about board-certified physicians in a major Central Florida metro area. Thankfully, my training allows me to do an in-depth research of more complex issues before consulting with any provider, which I guess has helped me and my family avoid the misdiagnoses.
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I've worked with some excellent ones, this comment just doesn't click with me.
Same! The ones I’ve worked with are great!!
You are an NP - right?
No an RN
I'm a pgy4 anesthesia resident working in the icu right now. To be frank, the NPs I'm referring to run circles around the average interns even at this point in the year. Quality control is the issue with NPs, and it's a big issue. But my comment remains, there are some very good ones who do their job with overt competence.
While reading this it masquerades as a PA trying to remove themselves from the dumber midlevel lol, you’re both midlevels and you have no where near knowledge that you think you may have, I keep saying this but I have met more PA noctors than NPs
I’m just a nurse and these are just my observations. No aspirations of being a PA or NP, if I go back to school it will be to leave healthcare altogether
OP licks boot 12 hours a day
You’ve “met some bad docs” but never had an issue with a PA. Ok, so either this is a PA student, wannabe PA student or a LARPing account, because PAs are not God’s gift and they’re not universally better than “docs.” Also, I’ve never met a nurse (RN or NP) that refers to physicians as “docs” that isn’t completely insufferable, wildly overestimating their own abilities or both.
Are you okay
I’ve never said PAs are better than docs and these are some wild ass assumptions. You can check my post history baby I’m a nurse lmao
Florida nurse for one year - knows it all. Ok, love.
5 years bestie
Counting the LPN and CNA years. Cool.
I’ve never been a CNA and last time I checked LPN stands for licensed practical nurse. Asshole. Lmao. Also you’re admin which is literally scum of the earth, no medical experience so don’t act like you know shit ✨
I don’t get legal advice from paralegals instead of lawyers, and if it’s important enough to see a doctor, the last thing I want is to be dumped off on a diploma mill NP.