By Christine Moffa, MS, RN, AJN clinical editor
By Richard Danby/via Flickr
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
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 spent more time with me than any medical doctor ever did. And people often point out that NPs work in poor and/or rural areas that have a tough time recruiting physicians. But by promoting ourselves as a cheaper, less busy alternative, are we doing ourselves a favor or confirming the suspicions of those who—despite the available research to the contrary—say we’re less qualified than physicians to provide effective primary care? I’m still looking to go back to a post–master’s certificate program to become an NP because I’d like to work in that capacity one day. I’d like to hear from any NPs or DNPs about how they handle these kinds of questions. How are you like physicians, and how do you differ?
I can understand why Verdad feels as she does; however, physicians are responsible for more errors than nurses. Indeed, nurses have long played a critical role in error prevention.
Experience is critical, and the nature of training is only part of the picture. I have two cousins who are M.D.s–one of whom is an idealist and trained at Hopkins before choosing to work at a public hospital that provides access to an under served demographic in a big city.
I have tremendous respect for the sacrifices involved in completing med school. Unlike Verdad, however, I have found that nurses, who invariably spend more time in direct patient contact, are often able to provide superior care.
The nature of managed care has undermined the ability of physicians to spend adequate time with patients. This issue is being addressed under President Obama’s ACA, but will have to be scrutinized on an ongoing basis.
God bless M.D.s and D.N.P.s. The evolution and elevation of the D.N.P. is not some nefarious invention of the nursing profession, but a response to the need for individuals trained and willing to provide primary care.
I don’t know the details of Verdad’s prescribing incident involving the NP and M.D., but surely he recognizes that such errors occur for a variety of reasons—not necessarily because a given provider is incompetent. Similarly, she takes a swipe at an NP who (according to her friend) was responsible for a miscarriage due to mismanagement of high blood pressure.
It is natural to generalize from what one has experienced, but this is not a reasonable way to assess the role and value of an entire profession. Nurse midwives, for example, have increasingly assumed a vital role in prenatal care and delivery—although they are not M.D.s.
Training alone is no substitute for experience, and I would much rather be treated by an experienced NP than a newly minted M.D.
Conversely, the newly minted NP needs to understand his/her limits and seek advice when necessary.
There is one way in which nurses—from the RN to the DNP–may have an advantage over M.D.s–and that is an absence of the God complex.
This is—indeed—a turf war—and that can only hurt patients. Where there is incompetence, that needs to be highlighted and, if based on inadequate training, rectified. But let us look clearly and dispassionately at the totality of the circumstances and not take cheap shots at those dedicated individuals who choose to become nurse practitioners OR physicians.
Portella is right when saying “the initial spark that drives nurses to nurse makes us different and better suited” -> to be a nurse, not a physician. There is no short cut to be a physician. Obtain your bachelors degree, then go to medical school, and then get the specialty training needed to do the job well, safely and effectively. No one is better trained than a family physician for the one-on-one contact of direct patient care. These are the primay care physicians, a special group of people that sacrifice the glamour and wealth of other specialties because they care about patients. God bless a family physician for saving me after an NP prescribed Celebrex when I am allergic to sulfa. And a dear friend just lost a pregnancy due to poor management of blood pressure. Sorry but I cannot respect someone for trying to do more than what their training was meant to do. I have great experiences with nurses doing nursing. There is no turf war. I do now what I am good at, not what I originally wanted to do in life. That is actually a good thing since there are no short cuts in life
As far as the primary care role of NPs goes, I don’t think that many could argue that nurses are better trained for the one-on-one contact of direct patient care. Please don’t get me wrong (no MD bashing here), I’ve been to and know many MDs who are great with patients. I can also say the same opposite of RNs. I believe that the initial spark that drives nurses to nurse makes us different and better suited.
DNP will very soon be the entry level for practitioners, so don’t bother with the MSN. NP’s don’t have the training nor the clinical experience comparable to MD’s, while they have advanced training it falls very short of the training and experiences of MD’s. Within their scope of practice they deliver comparable primary care results, however; compared to MD’s, their scope and range is more limited. I hope the DNP will resolve this and that we can become like DO’s who have the same training as MD’s + manipulation expertise and experience.
The uses for and modes of practice for NPs are as varied and wide ranging as they are for MDs. You speak to a vary limited scope of function for NPs. I am an RN and have seen a lot of NPs used as auxiliary personal to help better manage large numbers of patients. I feel that this is a great role for them to play, in addition to the primary care function other NPs fulfill.
As far as the primary care role of NPs goes, I don’t think that many could argue that nurses are better trained for the one-on-one contact of direct patient care. Please don’t get me wrong (no MD bashing here), I’ve been to and know many MDs who are great with patients. I can also say the same opposite of RNs. I believe that the initial spark that drives nurses to nurse makes us different and better suited.
Who knows, the level of education that advanced practice nurses receive many one day be the new RN standard. Fun thought: my grandmothers textbooks in nursing school were about as thick as a pamphlet on diabetes is today.
Thanks so much for this article; it validates my decision to switch from a master degree in nursing education to a DNP program. I have been a nurse for more than 25 years and was feeling very torn by the thoughts of leaving my nursing practice (let alone wondering how I would be able to afford my children’s education on a nursing faculty salary!). I will start my DNP program this summer and look forward to increase my clinical knowledge. I am very proud to be continuing my education and feel that I will be well prepared to provide care to my patients at a higher level. I understand Miss Moffa’s concerns about the role confusion, but it is clear to me that I will be providing advanced nursing care, not medical care to my patients. I will be proud to continue to be a nurse and I know that the combination of my bedside nurse experience and further education will have me well prepared to take care of my patients.