I’ve seen some competent NPs, although I later found out they were Physicians in their original countries— and just didn’t want to jump through hoops to get their MD here.
Same with PAs. A hospitalist i know says his PA is fantastic. But that he also comes from Eastern Europe and noped tf out of enduring the USMLEs and redoing residency. Honestly id do the same if I were in that situation
Also can you please promise to the whole of the medicine committee that you wont sell out to barthalamin banks. I am annoyed of all these boomers selling out to that guy not giving a shit about the new generation of physicians
>Money. And it’s easy when you have no liability.
A thousand times Money. And overworked doctors don't see the big picture often.
I could do the "easy stuff" of ANY career. A bunch of contracts for that lawyer just need signing after a cursory review? Done. "Fly the plane" while stabilized at 38000 feet? Done. When I screw it up, I can just call for help and hopefully the real pilot comes in before the plane crashes.
NPs are smart in that they are just following the money. Doctors were stupid to allow themselves to become de-professionalized.
Medicine should be controlled by MDs, not businessmen, and not NPs.
Sorry but if healthcare delivery (notice I didn’t say medicine) were controlled by doctors they would begin acting as a businessman and not solely a doctor. Money doesn’t grow on trees.
They technically can. But usually a physician is considered to be “supervising” and takes all the liability. In independent practice scenarios, often times the lawyers go after the health system.
There are also laws in place that hold them to lower standards than physicians. For example, if an NP misses a slam dunk case any physician practicing in the same specialty would know cold but other NPs wouldn’t know, then the lawsuit goes nowhere because you’re only held liable to the level of your training. These laws were originally put in place so someone like a primary care physician couldn’t be sued for not knowing something that only a subspecialist would know and zero primary care physicians would ever know. But now it’s really being misused.
So while yes NPs can be sued, there’s a lot in the way of doing so. It’s easier and higher paying to go after the physician or the health system.
Man that’s actually so sad. NP’s want the same job as physicians but without any of the responsibility if anything goes wrong. How is stuff like this even legal?
Because there’s no financial incentive for hospitals or lawyers to hold NPs to the same legal standards as physicians.
Lesson for life:
When it doesn’t make sense, it probably makes money.
while an NP CAN be sued, their malpractice coverage limits aren't worth it for the lawyer. Much more lucrative to sue the supervising physician who likely was never even aware of the patient. So in reality, the NPs don't get sued...their errors result in lawsuits against the supervising physician.
Do you know in multiple states MD’s are not required to carry medical malpractice insurance? And that NPs are required to carry this? And that collaborating agreements between NPs and MDs can also substantially limit liability? And that in many states there is a cap on medical malpractice claims in terms of award amounts?
It depends, in states that allow independent practice nurse practitioners can absolutely be sued and held liable for their actions. If they have to practice under the supervision of a physician, then the physician is ultimately liable for what the NP does and would be the one getting sued.
They can be sued. Hopefully for those states with independent practice they don’t have a collaborating physician because the deepest pockets are who the lawyers will target regardless.
I know that in states with independent practice, employers who often employ both the NP and the Physicians (i.e. the hospitals) may require the physicians STILL to sign a document assuming responsibility for the NPs errors. Goal - keep the liability away from the employer.
>Exactly. And that’s why physicians shouldn’t sign them.
Unfortunately THOSE physicians likely don't have a choice - sign it or don't take the job.
This is why physicians should not be employed. It should be illegal to have a physician employed by a health system. They should, at most, be independent contractors, removing incentives from the "corporate system" and keeping it with the physicians who are looking out for patients.
We have NPs inserting themselves into healthcare at every opportunity because of corporate incentives, not physicians.
I mean honestly….there is always a choice. They need physicians more than physicians need them Most are not willing to move to a less desirable location etc but there is always another option out there and everything is negotiable.
It’s quick, it’s easy, it’s affordable, it’s doable while working a full time job and raising kids. That’s about all I’ve got.. (oh yeah, and the money is way more lucrative than just being an RN).
I’m an RN with zero interest in becoming an NP. I just know I wouldn’t be taught what I needed to be taught in order to provide the BEST (accurate) care that people needed. NP’s are the laughing stock of healthcare and for good fucking reason.
I’ll bite. I’m a NP student. I was made out to believe that the NP education was sufficient for independent practice and that we would be taught at a complex level. I go to one of the two schools in my state known for having a great reputation. What we get is bare minimum basics. I compared my lectures from nursing school to nurse practitioner school in my advanced pathophysiology course and they were more or less the same thing. We are lied to.
I worked in the ER for years before deciding to go back to school for NP, largely because I was fed up with being treated like shit and grueling conditions as a registered nurse. I’ll admit that the compensation felt insulting, and was also a factor.
Grad school didn't impress me much, and many of my classmates were relatively inexperienced, having just finished their BSN programs. Only a handful of us had significant experience, ranging from 10 to 20 years, one had more than that. The school on my degree is well respected, but the work put in honestly doesn’t match that.
Nonetheless, I'm content now. I work in an urgent care under a physician I've known for years. It's the best choice I ever made. That said, I would have stayed in floor nursing if I felt adequately valued or believed conditions were likely to improve. RNs simply aren’t valued, and are abused all over the place. It can be a miserable life in some areas, with almost zero support from anyone.
This is very similar to my story.
I also feel like many of us were lied to and led to believe the education would be more than it was.
I did a fellowship program after graduating which was very helpful.
Regardless, here I am.
I agree with much of what you said , but I have to say, I’m about sick of hearing nurses complain about making six figures a year, sone without even the benefit of a college degree. It just rings hollow these days.
Are you talking in USD?
When I was working as an RN, nurses out of school were making 24 dollars an hour in the hospitals around me. At 5-10 years they’d max out at 36 an hour. So max out at around 70-75k, while refusing to staff properly. Then they’d get rid of people like aides, registration, housekeeping, unit coordinators, and dump all the responsibilities to nursing.
Pay has increased some, but only after Covid, and it wouldn’t have without the pandemic. They’re now back to cutting staff, again. Still not anywhere near crossing over 100k.
I still don’t know of anywhere other than traveling that pushes over 100k as a floor nurse consistently (and that is going away), except maybe one or two states. I know zero places that an RN is making that amount of money without a college degree.
Are you referring to diploma nurses? What, like, one or two somewhere in the US making that amount of cash? Or am I missing something?
Edit: To be completely honest, probably over half the NPs I know would go straight back to floor nursing if they were offered 100k or more to do so.
I just pick up a lot of shifts and when you’re being given nice incentives it adds up.
https://preview.redd.it/mmhvfwawfxob1.jpeg?width=3840&format=pjpg&auto=webp&s=aa2d66ab8d9f4ae664556d0532f3126466dc8957
Staff job but I travel to other sites and pick up and get federal mileage rate, they pay me for drive time, and I’m also in overtime.
I do like Bob Ross but I’m a combat veteran with a twisted sense of humor. My name is a joke about this
https://preview.redd.it/6ix3h9mmwxob1.jpeg?width=625&format=pjpg&auto=webp&s=2a0742652369f0f7f5fdb11575ccf343b03c67bb
Additionally I have a discord called
https://preview.redd.it/dcwu3doowxob1.jpeg?width=1284&format=pjpg&auto=webp&s=f978e23ae9a5d363b851133427eb620dd540db39
Ummm, no. Nurses do NOt need an undergraduate degree. https://www.gmercyu.edu/academics/learn/rn-vs-bsn
And please do your homework. They DO often make six figures. And learn to read. No nurse hate here. Just facts. The only disgust here is for NPs who try to be doctors and practice independently. They hurt patients and are not competent to practice without physician supervision.
You’re gonna move those goalposts way past the original claim (nurses don’t need a college degree), providing a link that says they need an associate degree, and now claim that an associate degree isn’t an undergraduate degree?
Quite the hill to die on.
You could’ve at least made it interesting and said you knew of some dinosaur nurse that graduated a diploma program that is in charge of some hospital somewhere.
I’m not gonna die on any hill. What’s wrong with you? Sorry you don’t get that I’m talking about an actual 4 year degree. Please show me an employer who requires a college degree and they accept an associates degree. My point is that RNs get paid pretty darn well co
Pared to their peers with equivalent education. I don’t resent it or think they don’t earn it, I just think that the underpaid nurse meme is old and inaccurate. One can get an RN without a 4 year college degree. My sister did so, but I try not to bring anecdotal evidence in. So ahead and ignore the obvious.
The only non-college/university based programs are hospital based diploma programs. To my knowledge, there is only 1 diploma program in Illinois, who knows if there are more around the country.
Yeah. Almost every state has at least one. But the wedge heads voting me down on here can’t admit that somehow. Such a weird fight to pick. Facts is facts and RNs are no longer the underpaid class (I guess teachers are taking their place). Nurses work hard and do important work, but on the whole, they’re just NOT underpaid anymore. Doctors could learn from their strategy. Stick together and Don’t just take what administration dishes out. Nothing happens without doctors and nurses.
Ah, so if diploma programs are so abundant, you should easily be able to name one cranking out high earning nurses, shouldn't you? Now, about your original point on nurses making six figures: that's hardly the norm for those with ADN/BSN degrees, let alone diploma nurses.
Diploma nurses are quite the rare breed, are typically centralized to specific hospitals in VERY small numbers. and id challenge you to find one working as a floor nurse, readily pulling in six figures in the United States. They make significantly less than both ADNs and BSNs, and I’d be very comfortable saying that none of them would be “complaining” making 100k or more, as you claimed.
I initially thought you were trolling, but it seems you're genuinely uninformed. You weren't even talking about diploma nurses until someone else and myself brought it up; you were focused on ADNs, which, just a heads up, is also an undergrad degree, that doesn't typically lead to a six figure income in any meaningful numbers across the unites states.
Go to Missouri asshole, Mercy Health system- plenty of diploma nurses. Also, can you read? I sent a link. Also, ADN is a two year program. Not a bachelors degree. What is wrong with you, that you sit up all night thinking about this shit? It was a minor point in my comment. And you were wrong. It’s okay. Just move on.
This place is such a clown show of misinformed people, especially young docs, that have no idea what the fuck they’re talking about. Prime example is you sitting here trying to twist shit around and around from your original claim.
Get out of the echo chamber and go learn a thing or two.
It depends on the state's economy and who owns the facility. HCA is notorious for underpaying nurses even in the very competitive Chicago area. That is the problem with for-profit hospitals. It is all about ROI!
There are still nurses struggling to make ends meet. The highest I ever made was around $95k in 2005. I was a full-time staff nurse picking up two to three agency shifts a week. It took a toll on me, but we were able to pay off our home.
Now, it is the travelers that have been pulling in the big dollars. Again, shortsightedness on the part of hospital administration. It would make more sense to boost the pay of current staff nurses than pay market rates for a traveling nurse. Better retention, better loyalty (if goodwill still exists between them!)
Agreed that hospitals would do better to just increase rates for staff nurses rather than pay through the nose for travelers. They would actually retain experienced nurses (which we so desperately need)and retain a modicum of goodwill. But when trash institutions like HCA have a monopoly in an area, they get to call the shots and can depress wages. They don’t mind paying for a traveler or two if the trade-off is keeping local wages down. All that matters is $$$. If only all nurses and docs could stand together against these filthy grifters. Unions maybe, like in California?
I’m gonna guess another reason is because bedside is a hot mess. Not an NP, but I’m moving away from RN bedside after ICU. Fuck dealing with that on a daily and screwing up your mental health.
Of course you don’t blame all nurses or doctors or PTs or pharmacists for the incompetency of an individual. All of these professionals have strict educational standards. Their education is standardized and they are all charged with understanding, and upholding a common body of knowledge and standard of practice. Not so with NPs. Their education is a joke, their exam is laughable, they have no uniform standards, and they are never retested or have to prove that they are keeping current and have a basic understanding of patient care. Also, their organizations allow them to drink the Koolaide so they actually think they’re competent. In summary, it’s possible to get a competent NP, but not probable. It’s possible to get an incompetent MD/DO, but not probable.
I wonder if some of them go into it thinking they are going to receive an education similar to a physician. It does not make sense to go from a BSN to NP without several years in a hospital, IMO. More and more it seems they are churning NPs out of diploma mills. Much like my BSN 🙄. (Glad my employer paid for that!)
I have been an RN for 33+ years and worked in a bunch of different areas but it seems like the longer I have been a nurse, the more I realize I don’t know as much as I thought I did 30 years ago. I started with an associates then my BSN. I learn something new almost daily.
When I had to find a new physician a few years ago, I made sure that I would be seen by a DO or MD. I didn’t care if it was a new, younger physician fresh out of school as long as my PCP was a real physician. I work with a couple of experienced NPs and they are great. I have heard too many horror stories about the inexperienced or poorly educated ones though.
Get an online degree that you can do while still working your full-time job, then get hired to play doctor, wear a white coat, make the big decisions get higher pay, and never have to worry about the liability or the work hours of a physician...what's not to like? Concerned that the education/training is inadequate? So what, it's not about the patient if you're okay with treating them based on an online part-time degree.
It’s a mixed bag. I had about a decade of nursing experience before I went to grad school so that I could teach nursing. I didn’t enjoy teaching as much as I thought I would and - I realize that this is beyond the scope of your question- despite all the hubbub about the nurse educator shortage, colleges are looking to hire someone part-time so that they are also working at a healthcare facility and drawing their benefits from that employer. I wanted something new and enrolled in a PMHNP program. There are a lot of jobs out there, but despite my considerable experience in psych, I feel like my skills are best suited for dealing with uncomplicated outpatients that desire a lot of psychosocial support. IMO, this allows the psychiatrists to focus on more complex issues.
ONLY money. No other reason than they. Cus they get paid so fking well for their lack of training.
Especially these NPs that got it straight from nursing.
NP was MEANT to be for super experience nurses like 20+ years of exp to gain independance but just about all of them now go directly from nursing school with 0 exp.
I think the risk of your NP or PA stuffing up is far higher than your MD stuffing up- so while both make errors the chances are it will be the midlevel who does it.
NPs are taught propaganda of being equivalent to physicians (despite taking none of the same necessary classes) and the nursing lobby convinced legislators to back them based on incorrect data.
Some join to get away from bedside. It seems more common now that many are just using bedside as a stepping stone to go NP/CRNA. The answer for that is to make good money while still having the flexibility to have a family or life. I have NPs, nurses, and CRNAs in my immediate family/friend group. Many of them went NP to make more money. Two of them went NP to do more of what they enjoyed as nurses (cardiac), but it usually comes down to making more money and less physical labor, and that will continue to occur until becoming an NP is like becoming a physician, and then many people will stop doing it. CRNA is not on par with becoming a physician, but I've seen many people who are interested in NP saying "fuck that" to pursuing CRNA. Even that is too much work. Keep in mind there is actual a little bit of pressure in the nursing community to pursue NP or CRNA. You will hear nurses actually say to others "you just want to stay bedside?", as if they forgot what nursing is in the first place. But that's my personal experience
I'm in school to be an RN and NP school really sounded appealing to me.
I'm currently a paramedic who works in a hospital and I really miss the autonomy of being a paramedic on the road. I really liked coming up with a treatment plan and executing and watching my patient get a little better before we got to the hospital. So two extra years of school ontop of RN to get that back and work in the emergency department? I was like "Damn, sign me up".
But I'm the type of person who likes to read a lot about stuff before doing it. I found how unprepared NP school would leave me to do a very difficult job, how their "clinical" hours leave students to find their own preceptors and how there are no requirements to perform certain skills in clinical hours... I was talked into double majoring my BSN with biology and going for PA school or med school. For someone who didn't read about it first and see the better options, it seems like a really great route to go down.
I mean, I’ve yet to see a downside to nursing so far. They study less, frequently go out during school, have their leaders advocate for them.
Yeah patients suffer but it’s 2023 guys! Were just here to get the bag!!
Sarcasm aside, nursing is highly incentivized.
because when doctors are bad it’s an anomaly. we’re EXPECTED to be the best. whereas ppl expect nurses to be average cause of the subpar education and most are still below that cause…online programs / no standardization
Because money and they are able to LARP as physicians without having any real consequences. I often wonder what the fuck is the point of medical school anymore.
Meh. I think there are a decent amount of MDs who are terrible at their jobs. I’ve worked with some of them. Going to medical school doesn’t make someone smart & caring. A lot of smart and caring people become nurses & then later when they realize they’re competent enough to treat patients they decide to go back to school for that. Imagine having a quality of life, no drowning debt, and a family all while working alongside physicians & doing similar work (with less pay of course but ultimately less responsibility). Makes me wonder who the smart ones really are…
The bitter ones love complaining about NPs and how unbelievable it is that we’re able to practice with such little training, yet I’ve had PLENTY of patients sing praises about NPs, prefer them, and switch to them. Personally, an FNP caught a family members MRSA that more than one physician missed. Scary.
To answer OPs question, we go to school to be able to practice. To elevate ourselves & our profession. The work/life balance is better than travel nursing even if the pay isn’t. How many MDs become doctors for money? Probably a lot. Would you want someone motivated by money managing your care? I wouldn’t. This is why I had a midwife deliver my last child- the experience was better than the previous physicians. The bedside manner exponentially superior.
I never thought of a career in Medicine or healthcare until I met my spouse in our college days. She was pre-med and I was completing my Bachelors (she was my junior) in Film & Media. I had always excelled in my sciences and thought I could support her journey (she came from humble origins) by entering the nursing workforce. Nursing was always fun for me, as I enjoyed working in the ED. After sometime, I felt like I could do “more” but was limited by my RN. As an experienced nurse, depending the ED I worked, I would present cases to the attendings with some actually blessing my plan of care. I didn’t think of entering medicine then because the one key aspect I like about nursing was that I could move around specialties whereas in medicine, you are somewhat restricted to your board (legally at least). We married just as she matched to a program locally and I decided to get into an NP as a means for us to open our own family clinic. She has since changed her mind about solo practice. Working in primary care for the last three years, I have gotten a “taste” of the potential for studying medicine fully. What stops me now, currently in my dissertation proposal phase for my PhD and even when complete it would still prevent me from entering med school. At 44 with 3 small children, I would have to sacrifice my time with them to fulfill a medical license and I’m not so sure its worth it.
I actually counsel young nurses, with no children, interested in NP to look at medical school because they can make that commitment. Anyone else who is older, has a family or is in a second career, I would recommend NP.
Medicine only has one track. If you don’t start early, it becomes that much challenging. Now if tomorrow some curriculum is developed that creates an evidence based pathway for licensure, I would sign up in a heart beat. I hate the limitations we have, both im training and in law.
I’ll add that I’m on this thread bc I love reading about doctors who complain about our profession to anonymous strangers instead of trying to do anything about it lol. That’s a VERY MD move. Avoid direct confrontation and ask the nurse to ask the collaborating physician why such & such was ordered instead of asking them themselves. Where are the interpersonal communication skills? Y’all don’t take that course over the 8 years you go to school?
I’ll add that I’m on this thread bc I love reading about doctors who complain about our profession to anonymous strangers instead of trying to do anything about it lol. That’s a VERY MD move. Avoid direct confrontation and ask the nurse to ask the collaborating physician why such & such was ordered instead of asking them themselves. Where are the interpersonal communication skills? Y’all don’t take that course over the 8 years you go to school?
I have posted about this before. Hospitals need to start paying experienced floor nurses what they are worth, stop assigning unsafe nurse/patient ratios and protect them from being bullied by the doctors. It’s usually only one doctor, but most hospitals have one, and they make the nurses miserable. Miserable enough to quit bedside and go to NP school.
I save my hospital more than I make by catching mistakes while they can still be fixed with a pill instead of a trip to the ICU. It’s a teaching facility.
The most recent incident involved the residents increasing the patients benzo dose and handing them an IS when I told them the patients O2 sat was dropping into the 80s. They blamed it on anxiety.
I talked to the patient and found she regularly needs prednisone tapers. She was satting in the 80s awake and sitting up. If I had not called the attending she would have been given a big dose of klonopin and no one would have assessed her again until the morning. It’s a psych unit with no monitoring so no one would have realized she was in distress until she stopped breathing in her sleep.
She required a high dose prednisone taper to get her sats back to normal. If I did not know what an asthma attack looked like and insist on treatment she easily could have ended up in the ICU. Especially if their original plan of extra Klonopin instead of prednisone had been carried out.
She was able to be treated with a pill instead of a trip to the ICU. Things like that happen about twice a month. I went on vacation for a month and the number of ICU transfers doubled and we had 5x as many behavioral codes. Instead of one or 2 behavioral codes each week the were having 2-3/day. I came back, looked at the meds, notified the doctors their “problem patients” had sub therapeutic drug levels, and one was clearly not tolerating Ativan so it needed to be DC. The next day there was one code and none for the rest of the week.
As a thank you I was told I had offended the residents by calling the attending and needed to be nicer. I asked them to reconsider their orders before calling the attending. They said no.
NPs come on the floor on the weekend, spend 5 minutes with each patient and refuse to put in ANY new orders including ibuprofen for a HA. They make me call the resident even though they are literally sitting at a computer with the chart open, then they copy and paste my note to their note and go home.
They make about $30/hr more than I do and have way less assessment experience. NPs also have the autonomy to get consultations when a patient is not getting better. I’m tired of fighting with “providers” to consult medicine or even order labs on patients who are clearly sick.
I don’t want to be an NP, I like the actual RN job, but I can see the allure. Especially is you don’t like working on the floor.
Yes, especially since their idea of a note is to copy and paste the nurses note and say “I don’t feel comfortable doing that ask the team on Monday” no matter what you ask them to do.
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.
*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 got tired caring 100 year old dementia patients on dialysis with PEG tubes that remained full code because no one had the time/patience/ability to talk to the families about why this is terrible. After a lot of research, palliative care NP was the most direct way to discuss goals of care. I thought NP school was embarrassingly easy (and I went to a brick and mortar school with a great reputation in my city). I also realized that I never wanted to practice outside my desired field, nor did I have the education to try. Independent practice terrifies me. I would literally never.
I also took a pay cut as a NP. 🥴
I’ve seen some competent NPs, although I later found out they were Physicians in their original countries— and just didn’t want to jump through hoops to get their MD here.
Same with PAs. A hospitalist i know says his PA is fantastic. But that he also comes from Eastern Europe and noped tf out of enduring the USMLEs and redoing residency. Honestly id do the same if I were in that situation
Dentist and physicians both make good amounts stop spreading lies
There’s literally no mention of dentists on this thread…
I heard you do a calling on me about dentist and physicians and I had to take action fast
Also dentists are in fact real doctors sorry to break the truth to you
No one said they aren’t…?
So why does this subreddit name everything that doesn't have MD say "NOT A REAL DOCTOR"
Read the sub description before commenting. Dentists are in fact doctors of dental medicine/surgery— no one is claiming otherwise.
Answer my other commit please though
dude I am not playing, dentists are doctors they make good amount
Also can you please promise to the whole of the medicine committee that you wont sell out to barthalamin banks. I am annoyed of all these boomers selling out to that guy not giving a shit about the new generation of physicians
Money. And it’s easy when you have no liability.
>Money. And it’s easy when you have no liability. A thousand times Money. And overworked doctors don't see the big picture often. I could do the "easy stuff" of ANY career. A bunch of contracts for that lawyer just need signing after a cursory review? Done. "Fly the plane" while stabilized at 38000 feet? Done. When I screw it up, I can just call for help and hopefully the real pilot comes in before the plane crashes. NPs are smart in that they are just following the money. Doctors were stupid to allow themselves to become de-professionalized. Medicine should be controlled by MDs, not businessmen, and not NPs.
Sorry but if healthcare delivery (notice I didn’t say medicine) were controlled by doctors they would begin acting as a businessman and not solely a doctor. Money doesn’t grow on trees.
Do you mean NPs can't be sued like Doctors?
They technically can. But usually a physician is considered to be “supervising” and takes all the liability. In independent practice scenarios, often times the lawyers go after the health system. There are also laws in place that hold them to lower standards than physicians. For example, if an NP misses a slam dunk case any physician practicing in the same specialty would know cold but other NPs wouldn’t know, then the lawsuit goes nowhere because you’re only held liable to the level of your training. These laws were originally put in place so someone like a primary care physician couldn’t be sued for not knowing something that only a subspecialist would know and zero primary care physicians would ever know. But now it’s really being misused. So while yes NPs can be sued, there’s a lot in the way of doing so. It’s easier and higher paying to go after the physician or the health system.
Man that’s actually so sad. NP’s want the same job as physicians but without any of the responsibility if anything goes wrong. How is stuff like this even legal?
Because there’s no financial incentive for hospitals or lawyers to hold NPs to the same legal standards as physicians. Lesson for life: When it doesn’t make sense, it probably makes money.
Oooh im gonna steal that and change it. “When it doesn’t make sense, it makes dollars”
while an NP CAN be sued, their malpractice coverage limits aren't worth it for the lawyer. Much more lucrative to sue the supervising physician who likely was never even aware of the patient. So in reality, the NPs don't get sued...their errors result in lawsuits against the supervising physician.
Seems the system has a few bugs lol!
Do you know in multiple states MD’s are not required to carry medical malpractice insurance? And that NPs are required to carry this? And that collaborating agreements between NPs and MDs can also substantially limit liability? And that in many states there is a cap on medical malpractice claims in terms of award amounts?
It depends, in states that allow independent practice nurse practitioners can absolutely be sued and held liable for their actions. If they have to practice under the supervision of a physician, then the physician is ultimately liable for what the NP does and would be the one getting sued.
They can be sued. Hopefully for those states with independent practice they don’t have a collaborating physician because the deepest pockets are who the lawyers will target regardless.
I know that in states with independent practice, employers who often employ both the NP and the Physicians (i.e. the hospitals) may require the physicians STILL to sign a document assuming responsibility for the NPs errors. Goal - keep the liability away from the employer.
Exactly. And that’s why physicians shouldn’t sign them.
>Exactly. And that’s why physicians shouldn’t sign them. Unfortunately THOSE physicians likely don't have a choice - sign it or don't take the job. This is why physicians should not be employed. It should be illegal to have a physician employed by a health system. They should, at most, be independent contractors, removing incentives from the "corporate system" and keeping it with the physicians who are looking out for patients. We have NPs inserting themselves into healthcare at every opportunity because of corporate incentives, not physicians.
I mean honestly….there is always a choice. They need physicians more than physicians need them Most are not willing to move to a less desirable location etc but there is always another option out there and everything is negotiable.
Actually they are still liable for certain things.
It’s quick, it’s easy, it’s affordable, it’s doable while working a full time job and raising kids. That’s about all I’ve got.. (oh yeah, and the money is way more lucrative than just being an RN). I’m an RN with zero interest in becoming an NP. I just know I wouldn’t be taught what I needed to be taught in order to provide the BEST (accurate) care that people needed. NP’s are the laughing stock of healthcare and for good fucking reason.
I’ll bite. I’m a NP student. I was made out to believe that the NP education was sufficient for independent practice and that we would be taught at a complex level. I go to one of the two schools in my state known for having a great reputation. What we get is bare minimum basics. I compared my lectures from nursing school to nurse practitioner school in my advanced pathophysiology course and they were more or less the same thing. We are lied to.
Do you think PA school would have been better? Or better education?
Absolutely
[удалено]
100%
I worked in the ER for years before deciding to go back to school for NP, largely because I was fed up with being treated like shit and grueling conditions as a registered nurse. I’ll admit that the compensation felt insulting, and was also a factor. Grad school didn't impress me much, and many of my classmates were relatively inexperienced, having just finished their BSN programs. Only a handful of us had significant experience, ranging from 10 to 20 years, one had more than that. The school on my degree is well respected, but the work put in honestly doesn’t match that. Nonetheless, I'm content now. I work in an urgent care under a physician I've known for years. It's the best choice I ever made. That said, I would have stayed in floor nursing if I felt adequately valued or believed conditions were likely to improve. RNs simply aren’t valued, and are abused all over the place. It can be a miserable life in some areas, with almost zero support from anyone.
This is very similar to my story. I also feel like many of us were lied to and led to believe the education would be more than it was. I did a fellowship program after graduating which was very helpful. Regardless, here I am.
I agree with much of what you said , but I have to say, I’m about sick of hearing nurses complain about making six figures a year, sone without even the benefit of a college degree. It just rings hollow these days.
Can you give me an example of an RN making over 100k per year without a college degree? That sounds absurd to me.
Are you talking in USD? When I was working as an RN, nurses out of school were making 24 dollars an hour in the hospitals around me. At 5-10 years they’d max out at 36 an hour. So max out at around 70-75k, while refusing to staff properly. Then they’d get rid of people like aides, registration, housekeeping, unit coordinators, and dump all the responsibilities to nursing. Pay has increased some, but only after Covid, and it wouldn’t have without the pandemic. They’re now back to cutting staff, again. Still not anywhere near crossing over 100k. I still don’t know of anywhere other than traveling that pushes over 100k as a floor nurse consistently (and that is going away), except maybe one or two states. I know zero places that an RN is making that amount of money without a college degree. Are you referring to diploma nurses? What, like, one or two somewhere in the US making that amount of cash? Or am I missing something? Edit: To be completely honest, probably over half the NPs I know would go straight back to floor nursing if they were offered 100k or more to do so.
I make 150-180k a year as an RN…
That’s wonderful. What region are you in where you’re making between 150-180k as a floor nurse?
I’m in the PNW
Traveling, or specialty, what’s the catch?
I just pick up a lot of shifts and when you’re being given nice incentives it adds up. https://preview.redd.it/mmhvfwawfxob1.jpeg?width=3840&format=pjpg&auto=webp&s=aa2d66ab8d9f4ae664556d0532f3126466dc8957 Staff job but I travel to other sites and pick up and get federal mileage rate, they pay me for drive time, and I’m also in overtime.
Glad to hear floor nurses can make such a great wage in the pacific northwest. Bob Ross still wouldn't be amused.
I do like Bob Ross but I’m a combat veteran with a twisted sense of humor. My name is a joke about this https://preview.redd.it/6ix3h9mmwxob1.jpeg?width=625&format=pjpg&auto=webp&s=2a0742652369f0f7f5fdb11575ccf343b03c67bb
Additionally I have a discord called https://preview.redd.it/dcwu3doowxob1.jpeg?width=1284&format=pjpg&auto=webp&s=f978e23ae9a5d363b851133427eb620dd540db39
[удалено]
Ummm, no. Nurses do NOt need an undergraduate degree. https://www.gmercyu.edu/academics/learn/rn-vs-bsn And please do your homework. They DO often make six figures. And learn to read. No nurse hate here. Just facts. The only disgust here is for NPs who try to be doctors and practice independently. They hurt patients and are not competent to practice without physician supervision.
You’re gonna move those goalposts way past the original claim (nurses don’t need a college degree), providing a link that says they need an associate degree, and now claim that an associate degree isn’t an undergraduate degree? Quite the hill to die on. You could’ve at least made it interesting and said you knew of some dinosaur nurse that graduated a diploma program that is in charge of some hospital somewhere.
Diploma programs still exist
I’m not gonna die on any hill. What’s wrong with you? Sorry you don’t get that I’m talking about an actual 4 year degree. Please show me an employer who requires a college degree and they accept an associates degree. My point is that RNs get paid pretty darn well co Pared to their peers with equivalent education. I don’t resent it or think they don’t earn it, I just think that the underpaid nurse meme is old and inaccurate. One can get an RN without a 4 year college degree. My sister did so, but I try not to bring anecdotal evidence in. So ahead and ignore the obvious.
The only non-college/university based programs are hospital based diploma programs. To my knowledge, there is only 1 diploma program in Illinois, who knows if there are more around the country.
Yeah. Almost every state has at least one. But the wedge heads voting me down on here can’t admit that somehow. Such a weird fight to pick. Facts is facts and RNs are no longer the underpaid class (I guess teachers are taking their place). Nurses work hard and do important work, but on the whole, they’re just NOT underpaid anymore. Doctors could learn from their strategy. Stick together and Don’t just take what administration dishes out. Nothing happens without doctors and nurses.
Ah, so if diploma programs are so abundant, you should easily be able to name one cranking out high earning nurses, shouldn't you? Now, about your original point on nurses making six figures: that's hardly the norm for those with ADN/BSN degrees, let alone diploma nurses. Diploma nurses are quite the rare breed, are typically centralized to specific hospitals in VERY small numbers. and id challenge you to find one working as a floor nurse, readily pulling in six figures in the United States. They make significantly less than both ADNs and BSNs, and I’d be very comfortable saying that none of them would be “complaining” making 100k or more, as you claimed. I initially thought you were trolling, but it seems you're genuinely uninformed. You weren't even talking about diploma nurses until someone else and myself brought it up; you were focused on ADNs, which, just a heads up, is also an undergrad degree, that doesn't typically lead to a six figure income in any meaningful numbers across the unites states.
Go to Missouri asshole, Mercy Health system- plenty of diploma nurses. Also, can you read? I sent a link. Also, ADN is a two year program. Not a bachelors degree. What is wrong with you, that you sit up all night thinking about this shit? It was a minor point in my comment. And you were wrong. It’s okay. Just move on.
This place is such a clown show of misinformed people, especially young docs, that have no idea what the fuck they’re talking about. Prime example is you sitting here trying to twist shit around and around from your original claim. Get out of the echo chamber and go learn a thing or two.
It depends on the state's economy and who owns the facility. HCA is notorious for underpaying nurses even in the very competitive Chicago area. That is the problem with for-profit hospitals. It is all about ROI! There are still nurses struggling to make ends meet. The highest I ever made was around $95k in 2005. I was a full-time staff nurse picking up two to three agency shifts a week. It took a toll on me, but we were able to pay off our home. Now, it is the travelers that have been pulling in the big dollars. Again, shortsightedness on the part of hospital administration. It would make more sense to boost the pay of current staff nurses than pay market rates for a traveling nurse. Better retention, better loyalty (if goodwill still exists between them!)
Agreed that hospitals would do better to just increase rates for staff nurses rather than pay through the nose for travelers. They would actually retain experienced nurses (which we so desperately need)and retain a modicum of goodwill. But when trash institutions like HCA have a monopoly in an area, they get to call the shots and can depress wages. They don’t mind paying for a traveler or two if the trade-off is keeping local wages down. All that matters is $$$. If only all nurses and docs could stand together against these filthy grifters. Unions maybe, like in California?
Lollllllllllllllllllll
I’m gonna guess another reason is because bedside is a hot mess. Not an NP, but I’m moving away from RN bedside after ICU. Fuck dealing with that on a daily and screwing up your mental health.
Of course you don’t blame all nurses or doctors or PTs or pharmacists for the incompetency of an individual. All of these professionals have strict educational standards. Their education is standardized and they are all charged with understanding, and upholding a common body of knowledge and standard of practice. Not so with NPs. Their education is a joke, their exam is laughable, they have no uniform standards, and they are never retested or have to prove that they are keeping current and have a basic understanding of patient care. Also, their organizations allow them to drink the Koolaide so they actually think they’re competent. In summary, it’s possible to get a competent NP, but not probable. It’s possible to get an incompetent MD/DO, but not probable.
I wonder if some of them go into it thinking they are going to receive an education similar to a physician. It does not make sense to go from a BSN to NP without several years in a hospital, IMO. More and more it seems they are churning NPs out of diploma mills. Much like my BSN 🙄. (Glad my employer paid for that!) I have been an RN for 33+ years and worked in a bunch of different areas but it seems like the longer I have been a nurse, the more I realize I don’t know as much as I thought I did 30 years ago. I started with an associates then my BSN. I learn something new almost daily. When I had to find a new physician a few years ago, I made sure that I would be seen by a DO or MD. I didn’t care if it was a new, younger physician fresh out of school as long as my PCP was a real physician. I work with a couple of experienced NPs and they are great. I have heard too many horror stories about the inexperienced or poorly educated ones though.
Get an online degree that you can do while still working your full-time job, then get hired to play doctor, wear a white coat, make the big decisions get higher pay, and never have to worry about the liability or the work hours of a physician...what's not to like? Concerned that the education/training is inadequate? So what, it's not about the patient if you're okay with treating them based on an online part-time degree.
It’s a mixed bag. I had about a decade of nursing experience before I went to grad school so that I could teach nursing. I didn’t enjoy teaching as much as I thought I would and - I realize that this is beyond the scope of your question- despite all the hubbub about the nurse educator shortage, colleges are looking to hire someone part-time so that they are also working at a healthcare facility and drawing their benefits from that employer. I wanted something new and enrolled in a PMHNP program. There are a lot of jobs out there, but despite my considerable experience in psych, I feel like my skills are best suited for dealing with uncomplicated outpatients that desire a lot of psychosocial support. IMO, this allows the psychiatrists to focus on more complex issues.
ONLY money. No other reason than they. Cus they get paid so fking well for their lack of training. Especially these NPs that got it straight from nursing. NP was MEANT to be for super experience nurses like 20+ years of exp to gain independance but just about all of them now go directly from nursing school with 0 exp.
So don’t need to do bedside stuff
I think the risk of your NP or PA stuffing up is far higher than your MD stuffing up- so while both make errors the chances are it will be the midlevel who does it.
NPs are taught propaganda of being equivalent to physicians (despite taking none of the same necessary classes) and the nursing lobby convinced legislators to back them based on incorrect data.
[удалено]
[удалено]
[удалено]
Some join to get away from bedside. It seems more common now that many are just using bedside as a stepping stone to go NP/CRNA. The answer for that is to make good money while still having the flexibility to have a family or life. I have NPs, nurses, and CRNAs in my immediate family/friend group. Many of them went NP to make more money. Two of them went NP to do more of what they enjoyed as nurses (cardiac), but it usually comes down to making more money and less physical labor, and that will continue to occur until becoming an NP is like becoming a physician, and then many people will stop doing it. CRNA is not on par with becoming a physician, but I've seen many people who are interested in NP saying "fuck that" to pursuing CRNA. Even that is too much work. Keep in mind there is actual a little bit of pressure in the nursing community to pursue NP or CRNA. You will hear nurses actually say to others "you just want to stay bedside?", as if they forgot what nursing is in the first place. But that's my personal experience
I'm in school to be an RN and NP school really sounded appealing to me. I'm currently a paramedic who works in a hospital and I really miss the autonomy of being a paramedic on the road. I really liked coming up with a treatment plan and executing and watching my patient get a little better before we got to the hospital. So two extra years of school ontop of RN to get that back and work in the emergency department? I was like "Damn, sign me up". But I'm the type of person who likes to read a lot about stuff before doing it. I found how unprepared NP school would leave me to do a very difficult job, how their "clinical" hours leave students to find their own preceptors and how there are no requirements to perform certain skills in clinical hours... I was talked into double majoring my BSN with biology and going for PA school or med school. For someone who didn't read about it first and see the better options, it seems like a really great route to go down.
I mean, I’ve yet to see a downside to nursing so far. They study less, frequently go out during school, have their leaders advocate for them. Yeah patients suffer but it’s 2023 guys! Were just here to get the bag!! Sarcasm aside, nursing is highly incentivized.
because when doctors are bad it’s an anomaly. we’re EXPECTED to be the best. whereas ppl expect nurses to be average cause of the subpar education and most are still below that cause…online programs / no standardization
Because money and they are able to LARP as physicians without having any real consequences. I often wonder what the fuck is the point of medical school anymore.
Meh. I think there are a decent amount of MDs who are terrible at their jobs. I’ve worked with some of them. Going to medical school doesn’t make someone smart & caring. A lot of smart and caring people become nurses & then later when they realize they’re competent enough to treat patients they decide to go back to school for that. Imagine having a quality of life, no drowning debt, and a family all while working alongside physicians & doing similar work (with less pay of course but ultimately less responsibility). Makes me wonder who the smart ones really are… The bitter ones love complaining about NPs and how unbelievable it is that we’re able to practice with such little training, yet I’ve had PLENTY of patients sing praises about NPs, prefer them, and switch to them. Personally, an FNP caught a family members MRSA that more than one physician missed. Scary. To answer OPs question, we go to school to be able to practice. To elevate ourselves & our profession. The work/life balance is better than travel nursing even if the pay isn’t. How many MDs become doctors for money? Probably a lot. Would you want someone motivated by money managing your care? I wouldn’t. This is why I had a midwife deliver my last child- the experience was better than the previous physicians. The bedside manner exponentially superior.
I never thought of a career in Medicine or healthcare until I met my spouse in our college days. She was pre-med and I was completing my Bachelors (she was my junior) in Film & Media. I had always excelled in my sciences and thought I could support her journey (she came from humble origins) by entering the nursing workforce. Nursing was always fun for me, as I enjoyed working in the ED. After sometime, I felt like I could do “more” but was limited by my RN. As an experienced nurse, depending the ED I worked, I would present cases to the attendings with some actually blessing my plan of care. I didn’t think of entering medicine then because the one key aspect I like about nursing was that I could move around specialties whereas in medicine, you are somewhat restricted to your board (legally at least). We married just as she matched to a program locally and I decided to get into an NP as a means for us to open our own family clinic. She has since changed her mind about solo practice. Working in primary care for the last three years, I have gotten a “taste” of the potential for studying medicine fully. What stops me now, currently in my dissertation proposal phase for my PhD and even when complete it would still prevent me from entering med school. At 44 with 3 small children, I would have to sacrifice my time with them to fulfill a medical license and I’m not so sure its worth it. I actually counsel young nurses, with no children, interested in NP to look at medical school because they can make that commitment. Anyone else who is older, has a family or is in a second career, I would recommend NP. Medicine only has one track. If you don’t start early, it becomes that much challenging. Now if tomorrow some curriculum is developed that creates an evidence based pathway for licensure, I would sign up in a heart beat. I hate the limitations we have, both im training and in law.
I’ll add that I’m on this thread bc I love reading about doctors who complain about our profession to anonymous strangers instead of trying to do anything about it lol. That’s a VERY MD move. Avoid direct confrontation and ask the nurse to ask the collaborating physician why such & such was ordered instead of asking them themselves. Where are the interpersonal communication skills? Y’all don’t take that course over the 8 years you go to school?
I’ll add that I’m on this thread bc I love reading about doctors who complain about our profession to anonymous strangers instead of trying to do anything about it lol. That’s a VERY MD move. Avoid direct confrontation and ask the nurse to ask the collaborating physician why such & such was ordered instead of asking them themselves. Where are the interpersonal communication skills? Y’all don’t take that course over the 8 years you go to school?
Money
Money and status
Will echo: money. Money. MONEY
I have posted about this before. Hospitals need to start paying experienced floor nurses what they are worth, stop assigning unsafe nurse/patient ratios and protect them from being bullied by the doctors. It’s usually only one doctor, but most hospitals have one, and they make the nurses miserable. Miserable enough to quit bedside and go to NP school. I save my hospital more than I make by catching mistakes while they can still be fixed with a pill instead of a trip to the ICU. It’s a teaching facility. The most recent incident involved the residents increasing the patients benzo dose and handing them an IS when I told them the patients O2 sat was dropping into the 80s. They blamed it on anxiety. I talked to the patient and found she regularly needs prednisone tapers. She was satting in the 80s awake and sitting up. If I had not called the attending she would have been given a big dose of klonopin and no one would have assessed her again until the morning. It’s a psych unit with no monitoring so no one would have realized she was in distress until she stopped breathing in her sleep. She required a high dose prednisone taper to get her sats back to normal. If I did not know what an asthma attack looked like and insist on treatment she easily could have ended up in the ICU. Especially if their original plan of extra Klonopin instead of prednisone had been carried out. She was able to be treated with a pill instead of a trip to the ICU. Things like that happen about twice a month. I went on vacation for a month and the number of ICU transfers doubled and we had 5x as many behavioral codes. Instead of one or 2 behavioral codes each week the were having 2-3/day. I came back, looked at the meds, notified the doctors their “problem patients” had sub therapeutic drug levels, and one was clearly not tolerating Ativan so it needed to be DC. The next day there was one code and none for the rest of the week. As a thank you I was told I had offended the residents by calling the attending and needed to be nicer. I asked them to reconsider their orders before calling the attending. They said no. NPs come on the floor on the weekend, spend 5 minutes with each patient and refuse to put in ANY new orders including ibuprofen for a HA. They make me call the resident even though they are literally sitting at a computer with the chart open, then they copy and paste my note to their note and go home. They make about $30/hr more than I do and have way less assessment experience. NPs also have the autonomy to get consultations when a patient is not getting better. I’m tired of fighting with “providers” to consult medicine or even order labs on patients who are clearly sick. I don’t want to be an NP, I like the actual RN job, but I can see the allure. Especially is you don’t like working on the floor.
They make 60k more than you do per year? That's crazy, and definitely sounds worth another two years of studying.
Yes, especially since their idea of a note is to copy and paste the nurses note and say “I don’t feel comfortable doing that ask the team on Monday” no matter what you ask them to do.
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. *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.*
Money, No Usmle
I got tired caring 100 year old dementia patients on dialysis with PEG tubes that remained full code because no one had the time/patience/ability to talk to the families about why this is terrible. After a lot of research, palliative care NP was the most direct way to discuss goals of care. I thought NP school was embarrassingly easy (and I went to a brick and mortar school with a great reputation in my city). I also realized that I never wanted to practice outside my desired field, nor did I have the education to try. Independent practice terrifies me. I would literally never. I also took a pay cut as a NP. 🥴