Turf Wars Aside, How Do NPs and MDs Really Differ?

By Christine Moffa, MS, RN, AJN clinical editor

There’s been a lot of talk lately about turf wars between NP’s and physicians, especially when it comes to the much discussed U.S. shortage of primary care providers. Before going back to school and getting a master’s in nursing education, I batted around the idea of becoming a nurse practitioner. It seemed like the ideal next step for someone who was happy being a clinician but wanted to take on an advanced role.

However, there was something that didn’t sit right with me about becoming an NP—namely, my fear of public perception. I’m not sure most people know exactly what the role of an NP is and how it differs from that of a physician, particularly in primary care. I’ve seen patients call their primary care NP “doctor [insert first name here],” which to me illustrates the confusion.

When people ask me the difference, I myself have a hard time articulating it. How do I respond when someone says something like this: “if entry to medical school and residency is typically more competitive than for advanced degree nursing programs, and if physicians spend a longer time attending tougher programs, how do you justify their doing the same work as NPs?” (For instance, when I was in school we, along with the NP candidates, were only required to take two semesters of pathophysiology!)

Now, I’ve been to an NP as a patient, and I was happy with the care I received. She certainly […]

Are Nursing Strikes Ethical? New Research Raises the Stakes

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

Nurses at Temple University Hospital in Philadelphia have been on strike since March 31st over a number of issues including wages, health benefits, and a “gag order” that could prohibit nurses from speaking out against the hospital. Nurses walking picket lines is not a new phenomenon. What is new is research showing that patients suffer harm when nurses strike.

In March, a paper (subscription only) published by the National Bureau of Economic Research provided some evidence that nurses’ strikes have harmful effects on patients. The authors analyzed strikes (in all, 50 strikes in 43 hospitals) in New York State over a 20-year period and looked at what happens to inpatient mortality rates and 30-day readmission rates for patients admitted during a strike. They found that inpatient hospital mortality increased by 19.4% and that readmission within 30 days increased by 6.5%. The researchers asked, “Is this because [patients] receive less care, or because they receive worse care?” And, in an analysis to see if the results were different in strikes where management hired replacement workers, it showed they were not—outcomes were still worse.

These findings really shouldn’t come as a surprise. How can care be safe when there are fewer nurses than the normal levels (which often are already less than adequate for providing optimum care)? How can care be safe when replacement nurses—whether newly hired or shifted from other positions—are plopped onto units […]

“The Next Time She Needs a Pap Smear at 3 AM . . . “

Sunset, Turks and Caicos Islands


By Christine Moffa, MS, RN-BC,
AJN clinical editor

Vacations are an important part of keeping balanced in life and a good way to prevent career burnout. However, I’m sure that, like me, many of you have had to step out of relaxation mode to come to the aid of some unfortunate vacationer who either injured herself or himself trying a new activity, had a near drowning at the beach, or suffered some other tragedy.

I’ve just returned from a trip with six friends to Turks and Caicos. There was beach, sun, a lot of activities like snorkeling and the flying trapeze, and unlimited food and alcohol; in other words, it was the perfect set-up for a trip to the infirmary. (I once had a three-week nursing gig at a resort, so I know the usual ailments: overindulgence in food, alcohol, and sun; twisted ankles from people playing sports they haven’t attempted in the last 10 years; and the occasional serious accident or heart attack.)

Two days into the trip, one of my co-travelers fell ill with food poisoning, which resulted in a day’s worth of vomiting. At 2 a.m. my phone rang. It was this friend telling me that not only was she sick, but she’d just […]

Is Nurse Jackie Good for What Ails You?

[youtube=http://www.youtube.com/watch?v=5op6IdCXYqo]

Season 2 of the Edie Falco series on Showtime kicked off yesterday evening. Two immediate observations in passing: Jackie’s lifestyle is starting to catch up with her (so the show may be unrealistic at times, but it’s not all fantasy) and the episode’s most significant representation of patient advocacy showed Jackie on the phone trying to get a patient insurance coverage (good timing, on the eve of Obama’s signing of the health insurance reform bill).

We posted on “Nurse Jackie” from different angles (skeptical, enthusiastic) back during season one. It’s just entertainment, say many people. Others resent the less than idealized depiction of a nurse. Others find a heroic figure in Jackie despite her bad behavior. Or because of it. And so it goes. But the show does seem to have staying power. Are you watching? Are you a nurse watching, and how does that feel?

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Word Games? ANA Says We’ve Already Got a National Nurse; Others Disagree

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

On a new post at Homeland Voice, author Fiona Regina, MSN, RN, presents a rather critical discussion of the American Nurses Association’s opposition to the National Nurse initiative. She writes, “For heaven’s sake, it’s time for the ANA to get on board. The entire ANA organization would be better served by embracing motivated, politically active nurses willing to improve the health of our nation.” 

Regina offers several theories as to why the ANA might be taking the position (that is, aside from their stated reasons, one of which is that the U.S. Public Health Service already has a Chief Nursing Officer); what’s lacking in her piece, though, is any comment from the ANA to refute her charges or further elucidate their position. 

The ANA stance aside, the notion of a National Nurse keeps coming up and has support from many sectors. Diana Mason, AJN‘s editor-in-chief emeritus, argued for it here last September. More nurses should join the debate so that this issue can either move forward or be put to rest. What’s your opinion?
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