Cali NPs don't get independence

[LKPAC]

http://californiahealthline.org/news/california-nurse-practitioners-lose-battle-for-independent-practice-again/

 

Why aren't we PAs even trying for independence?  We have good reasons to believe we are better qualified.

[UGoLong]

There is a bill in Ohio that passed the House and is in the Senate now with no hearings planned. It will give NPs admission privileges and the right to be the attending HCP. Clearly hospitals get to decide if they will accept individual providers.

 

Not a good sign.

 

 

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[LKPAC]

The problem is that NPs are quickly becoming the second tier of providers behind physicians, leaving PAs as the third tier.  We need "supervision" and they do not.  This trend is becoming alarming.  If we don't wake up, we will be left behind.  As anything being done about this?  Where is AAPA?

[Acromion]

NP's who think they can practice medicine independently are the most delusional professionals currently working in our healthcare system and suffer from a bad case of Dunning-Kruger. No other profession is attempting to step outside of its boundaries in such an aggressive manner. We are talking about clinicians that can't even pass a watered down version of Step 3 who want to play doctor and put patients lives at risk. Unfortunately, PA's suffer by association. This is why I hate the term NP/PA. I don't want our profession tarnished by these delusional dilettantes who think they can play doctor after taking some online courses.

[NYCPAC]

I think this all has to do with the fact that the nursing unions across the country are stronger than PAs as unionized pa's are few and far between. That being said, I can't tell you how many pages/phone calls I've received from NPs asking the pa service where I work (nyc) how to treat acutely high BP or to read an ekg.....but they should be the admitting hcp right? I am not bashing NPs as I've met a few who are on top of their game but overall I have met way more PAs I'd trust with my life than NPs

 

 

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[cbrsmurf]

All this fluff you guys are talking about from your personal experience or not being able to pass a Step 3 test to doesn't really matter.  What really matters are the clinical outcomes.  If a panda who can provide equivalent outcomes to a physician, and is paid by a few pounds of bamboo a day, that panda should get full priveliges.

[Gordon, PA-C]

You guys are overreacting to this...

 

We need some PAs to chime in from these so called "independent NP" states.  Is the sky falling over there?  Are they all being fired from their jobs and replaced with NPs?

 

There are at least 20 states now with full NP independence, and the PAs in those states are thriving regardless.

[LKPAC]

You guys are overreacting to this...

 

We need some PAs to chime in from these so called "independent NP" states.  Is the sky falling over there?  Are they all being fired from their jobs and replaced with NPs?

 

There are at least 20 states now with full NP independence, and the PAs in those states are thriving regardless.

 

I'm in one of those states.  Our hospital is now hiring all NPs because that way they don't have to pay docs to "supervise" them.

 

I'm not suggesting that the sky is falling, but we can't bury our heads in the sand, either.

[Reality Check 2]

My long term problem is this:

 

NO regulation of NP education or programs - 9 weeks, 9 months, 16 months, 4 months, online, limited clinical, 80 HOURS of family practice. PAs have a regulated educational experience with a known set of mandatory rotations for set amounts of time.

 

Don't get me wrong, I work with some stellar NPs - we get along, we collaborate, we use each other's strengths. We don't compare degrees and we know each others' backgrounds and experience.

 

DO NOT THROW THE DOCTORATE OF NURSING IN MY FACE. 

 

That doctorate doesn't IMPLY any clinical skills. And, in fact, many newly minted DR NPs - don't have the clinical skills to match ANY new grad PA student. 

 

Most NPs I see in the community trying to bully for jobs can't suture to save their lives, can't splint, cast or reduce fractures and have very limited clinical experience outside of being an RN which isn't an NP which isn't a PA. 

 

Nurses  - nurse ------- PAs practice medicine after being trained that way. 

 

I cannot say it loud enough - PAs aren't getting any support or advancement and NPs ARE TAKING OUR JOBS - we are becoming an endangered species despite endless numbers of programs cranking out new grads.

 

We have to adapt, progress and gain some independence or we are going to die out - not tomorrow but soon.

 

Not over-reacting - just seeing the signs........................

[Poetsiren]

I worked with an exceptional group of NPs while I was a MA..... after already feeling biased towards NPs due to feeling they didn't treat me properly, I had the highest respect for these ladies because they were often better than the docs with their patients. They were highly experienced, imo, after decades in Hem/Onc, so they HAD to be. The docs trusted them and I even saw the NPs, because they basically ran that clinic, catch doc mistakes on chemo protocol forms - and witnessed the docs THANKING the NPs for catching them. These NPs worked exclusively in clinic, while the doc was swamped with both clinic and inpatient. Again - high respect went to these ladies!

 

However, after becoming a PA-C I went back to visit that office and a nurse asked me about the difference between PAs and NPs and my NP friend just stood there, so I answered. I said that basically we are interchangeable, that nurses graduate from nursing school, whereas PAs are educated based on the medical model, but when it comes down to it we can do the same things.

 

I was so offended when the next words out of her mouth were, "NPs now have to be a doctorate, though, so there's that. But I get grandfathered in so I really couldn't care less how it changes." I REALLY felt her stick her nose up at my profession. I just made a laugh that the area was NP saturated and went on with my conversation with the nurse on her lunch break.

 

During clinical rotations I worked with a Pediatrician who had stopped working with the NP program he was UNDER CONTRACT to help educate and now only preferred PAs. He said that the NP students had to come in maybe 3x per week for a few hours for a month to complete their peds requirements, whereas PAs had to come and work full 8-12-hour shifts alongside him every day of the week. It didn't take long, he said, to tell the NP program to tear up his contract because he didn't care that THEY didn't care to learn better.

 

PAs for the win!
And I seriously want the PA profession to grow and gain momentum the way the NP profession has! So many docs I've met are pro-PA as far as our education and skills versus NPs!

Yes - I feel slighted by the NPs. Sorry, I guess. And yes, they are independent here, too.

Welcome to my fight in KY.

Last dang state that STILL is fighting for ANY controlled Rx rights!

[PACdan]

I've said this before and I'll say it again, some NPs are coming out school with the notion that they are superiorly trained compared to PAs. And worse yet, some promote that idea when asked about PAs and NPs and how they compare.

 

I agree that there are stellar NPs and lackluster NPs, just as there are with PAs. I worked with an amazing NP last rotation. Before going into her speciality as an NP she was a floor nurse for 17 years in the same area of medicine she's now practicing in. For her, it probably didn't matter how rigorous or not her NP school was. HOWEVER; the only objective comparison we can look at for new graduates are the requirements of the two degrees. PA programs are incredibly standardized, NPs programs are not. We (PAs) average many more clinical hours and didactic hours in medicine at the time graduation compared to NPs. With exposure to more specialities to boot.

 

The old ways are gone, and both programs are taking more and more fresh faces with less time in the medical world before entry. As such, I think what is taught DURING school should be the focus of how we compare the two professions.

[UGoLong]

Several factors are leading to this:

 

- the lack of a supervision requirement for NPs (getting better for PA's; not long ago, my SP had to be within 60 minutes of where I am!)

- in some settings, docs don't want to "supervise" the way they used to. (I don't have that particuar problem.)

- the fact that NPs are the "tip of the spear" for the nursing boards and PAs and not to the medical boards

- hospitals have many nurses in decision-making roles. There are PAs here and there, but not many

- there are still more NPs than PAs

- companies support nursing (J&J etc) and who wouldn't? That kind of money gives NPs a lot of clout with legislatures. You get new laws by donating to reelection campaigns (I've seen it; don't get me started!)

 

I have worked with many wonderful NPs. I have also worked with new grads who weren't really prepared like a new PA would have been. 

[Acromion]

All this fluff you guys are talking about from your personal experience or not being able to pass a Step 3 test to doesn't really matter.  

 

 

 

Test questions are easier than actual patients. Multiple choice test questions have a single correct answer that is selected from a list. Patients often present with complex overlapping problems for which there are no perfect answers. If you don't have the knowledge to pass a simple multiple choice test, what makes you think you can get it right when it comes to actual patients? 

 

 

What really matters are the clinical outcomes.  If a panda who can provide equivalent outcomes to a physician, and is paid by a few pounds of bamboo a day, that panda should get full priveliges.

 

Define clinical outcomes. Are you talking about a few predefined targets like A1C or LDL? Or are you talking about something like all-cause mortality? I believe a study was conducted on the former scenario and was used as propaganda by the nursing lobby to promote NP's as independent primary care providers, which just goes to show how unethical they are, putting their own egos ahead of patient safety. The only way you could determine equivalency to physicians is to conduct a blinded prospective longitudinal study in which you randomly assign patients to either an NP or an MD and track them over a few decades and measure a battery of outcomes. This will never happen because it is clearly unethical.

[sillycibin]

So yes, the AAPA is changing their language in recommending how modern PAs should be used.  And supervision is being replaced with collaboration.  There are some other changes to make our language mirror more of that of an "independent" NP.

 

Excerpt:

"The AAPA House of Delegates (HOD) approved new “AAPA Guidelines for State Regulation of PAs” that reflect the continued evolution of the Academy’s position on PA scope of practice. The revised guidelines encourage states to allow PA scope of practice to be determined by the PA’s education and experience, rather than by physician delegation; repeal the concept that physicians should be responsible for PA-provided care; replace references to physician “supervision” with “collaboration”; and authorize state constituent organizations (CO) to pursue even more progressive provisions that would increase PA practice authority, should that opportunity arise. - See more at: https://www.aapa.org/twocolumn.aspx?id=6442451207#sthash.aoDqwMFC.dpuf"

[db_pavnp]

This will never happen because it is clearly unethical.

 

It is good to know that you require an inherently unethical study to believe that NPs provide decent care!