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 […]

2016-11-21T13:18:07-05:00April 20th, 2010|career, nursing perspective, students|6 Comments
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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 […]

2016-11-21T13:18:09-05:00April 16th, 2010|career, Ethics, nursing perspective|5 Comments
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Nurses Doing Primary Care, Hospital-Acquired Infections, Questionable Celebrity Advice, and Tort Reform

With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor’s watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called “Doctor.”

That’s the start of an MSNBC story called “Doc Deficit? Nurses Role May Grow in 28 States.” Much of the article is about nurse practitioners (NPs)–and the different ways they are (or are not) allowed to practice in different states, as well as the ongoing efforts of physician groups to limit their practice (even as the health care overhaul increases the demand for primary care physicians and invests in nurse-managed clinics). We’ve posted on scope of practice issues here more than once—what’s your take as nurses, or patients?

HAIs persist. Also today, as described from a number of perspectives in a collection of articles on Kaiser Health News, the Department of Health and Human Services (HHS) released a report stating that the rate of hospital-acquired infections did not improve in 2009, despite ongoing attention to this issue in studies, IHI initiatives, nursing journals, and nearly everywhere else. What gives?

Does getting sick make you an expert? Elsewhere, at Covering Health (the blog of the Association of Health Care Journalists), Andrew Van Dam is critical of tennis star Martina Navratilova’s public advocacy for yearly mammograms for women over 40.

In February, Martina […]

2016-11-21T13:18:11-05:00April 14th, 2010|health care policy|0 Comments
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What Matters to Today’s Nursing Students?

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

I just came back from the NSNA (National Student Nurses Association) convention in Orlando. What a crowd!  There were over 3,500 attendees, mostly nursing students and some faculty. And contrary to what one usually thinks of students on spring break, this group was serious and focused. Some impressions I took away from the meeting:

  • I was impressed with the many people pursuing nursing as a second career. I incorrectly thought several people I met were faculty because they looked older than many of the attendees—they were nursing students.  One had been a marketing executive, one a financial executive (for over 20 years!), one a regional manager of a cosmetics company, another a stay-at-home mom for 10 years . . . not to mention a bank teller who had been a caregiver for a family member who was quadriplegic. They had professional resumes; plans A, B, and C for job hunting; and were focused and organized.
  • Missing in the exhibit hall were hospital nurse recruiters. But presidents and representatives of nursing organizations were there, wooing potential new members either via booths or focus sessions. And with 80% of nurses not belonging to any professional association (according to Rebecca  Patton, president of the American Nurses Association, in her remarks to the group), associations need to figure out what would make these future nurses join their ranks.
  • Finding a job was the hot topic. I spoke with […]
2016-11-21T13:18:16-05:00April 12th, 2010|students|1 Comment
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