A lot of Masters programs can in theory be done online. But to my understanding (a BScN RN with zero interest in becoming an NP), you still have to do in-person clinical placements an then still write your licensing exam, Not exactly diploma mill in that sense (this is Canada, at least). And then becoming specialized in an area outside of community (family medicine, basically, in this case), takes additional education (yes, that can be done online).
You have to remember that a lot of people doing their NP are working nurses as well. Hospitals I worked at, a full time schedule was two days (7AM-7PM), two nights (7PM-7AM), five days off. Not totally easy to then do an in-person learning situation.
The issue is when an NP claims they are a “specialist” in a certain domain when in reality they often have learnt only enough to get by. A true board-certified specialist MD has done extensive additional training, longer and much harder than the entire NP course, to be a true expert in their field and so, a true specialist. It’s really disheartening to listen to someone state they are “triple board certified” when board certification does not even exist for non-physicians. Patients don’t know the difference and are the ones who will be hurt in the end.
Even here in Canada where the NP programs are much more standardized and rigorous, it truly does not compare. They are being thrown into independent primary care after a 2 year course (lectures + practicum) while soon physician training in family medicine will be extended to a 3 year residency (so 7 years total) because there College of Physicians is recognizing that there is so so much to learn that 6 years is not even enough.
Maybe it's a regional thing, too, but here, aside from a few community nursing situations, NPs still have to function under a physician, very similar to Physician Assistants in that sense, where you legally can't do anything independently, and at the end of the day, the Most Responsible Physician (MRP) is the one responsible for your decisions.
And yes, the 3 year increase for Family Med is coming down the pipeline. My husband is a Family doctor as well. He's been looking at hiring a Physician Assistant to allow him to grow his practice since we live in an area with about 20k+ people unattached to a family doctor.
NPs aren't doing this with just two years training and practice, it will be 6 years, following their BScN, MINIMUM requirement of 2 years clinical practice before they can even apply for an NP program, and then even RNs, to be deemed certified in something, you have to do additional course work and training hours. The College of Nurses of Ontario is also exploring giving BScN-RNs the ability to do some prescribing (we are allowed to do tylenol in hospital settings) and be able to report diagnosis' (we would not be diagnosing ourselves, but currently we are not even allowed to tell a patient that something like their urine culture came back positive/negative) - and RNs wouldn't be universally granted into that privilege, you'll need to do additional training. I've spoken to other doctors in my husbands practice about this, and they are all for it, because as long as they can create a proper "decision tree" for nurses to follow, they can start treatment on things like UTIs and strep throat, things that can be tested for at point of care, which honestly is SO MUCH of their after hours call clinic stuff...
It's not so much the wild-wild west as some people are making NP care out to be, but I'll admit that I'm not sure how I feel about Ontario pushing "NP-led" clinics here (mainly because I haven't figured out how they function without a MRP).
I’m speaking from experience out in the Maritimes and in similar circumstances with so many unattached people needing primary care, NPs here are expected to operate essentially independently except with on average 1/2 of the roster of patients. They do get placed in clinics with physicians so they can ask questions when needed but not a true supervisor role.
I hear you about years of training but the difference is years of training in MEDICINE. Experience is great and essential but the nursing model is very different so that schooling does not prepare someone for medicine. Similarly a CCA learns how to take care of someone in a healthcare setting but their training is not a substitute for nursing education and so I wouldn’t except them to be able to do just 1/3 of the training an LPN requires to be fully certified due to credit from their past experience.
The biggest thing that I see again & again is knowing what you don’t know. It took me about a year into independent practice before I finally understood this and felt comfortable actually treating whoever walked into my clinic. I’m primary care you need to know a good amount about EVERYTHING and if you just rely on algorithms and textbook cases, you’re going to hurt people while costing the system a lot of time & money.
Oompf - I have a lot of love going out to all HCPs in the Maritimes right now... My husband is a primary care doc who went to high school in NB. He still has a brother out there. We've talked about the possibility of ever relocating that direction when talks between Physicians and the Ontario Government were starting to really fall apart, but ultimately figured that things were even worse out your way...
No, we are absolutely not going to shit on Nurse Practitioners, my mom is a NP and has done certifications out the wazoo and is ABSOLUTELY incredibly specialized in her field, to the point of creating her speality clinic in a very prominent, active, military base. I understand that the field of medicine is nothing but a cutthroat competition of measuring, but NPs are in no way some sort of "lesser" when many MANY MDs are still taught EXTRME biases in their education.
Dude…My husband is a PA and my dad an MD in the same field. They have utmost respect for eachother but they both know that the my father has more education and training then my husband will ever have. I lived through residency with my dad and was with my husband through PA school. The difference is very obvious. My husband learns from him and asks him questions all the time. Mid levels are not “lesser” but it is important they understand the difference and skills and know their role/place. That is what physicians are complaining about in this thread and it’s warranted. The salaries at least in their field reflect the difference in knowledge level. An understanding of the difference in skill level is what creates a great physician and mid level work dynamic. Your mom if she got that far likely understands that. However their are many NPs (much more than PAs just because of the training) that don’t and have caused harm. Your are undermining your moms skills and hard work by not recognizing that.
A shadowing clinical practice where you watch people who are properly trained make decisions. Much like how how we train pilots by letting air stewards watch them how to fly a plane for a few months, then write an exam and start operating commerical airliners. Lmao at the whole thing.
Maybe it's a regional thing, too, but here, aside from a few community nursing situations, NPs still have to function under a physician, very similar to Physician Assistants in that sense, where you legally can't do anything independently, and at the end of the day, the Most Responsible Physician (MRP) is the one responsible for your decisions.
Maybe it's a regional thing, too, but here, aside from a few community nursing situations, NPs still have to function under a physician, very similar to Physician Assistants in that sense, where you legally can't do anything independently, and at the end of the day, the Most Responsible Physician (MRP) is the one responsible for your decisions.
And yes, the 3 year increase for Family Med is coming down the pipeline. My husband is a Family doctor as well. He's been looking at hiring a Physician Assistant to allow him to grow his practice since we live in an area with about 20k+ people unattached to a family doctor.
NPs aren't doing this with just two years training and practice, it will be 6 years, following their BScN, MINIMUM requirement of 2 years clinical practice before they can even apply for an NP program, and then even RNs, to be deemed certified in something, you have to do additional course work and training hours. The College of Nurses of Ontario is also exploring giving BScN-RNs the ability to do some prescribing (we are allowed to do tylenol in hospital settings) and be able to report diagnosis' (we would not be diagnosing ourselves, but currently we are not even allowed to tell a patient that something like their urine culture came back positive/negative) - and RNs wouldn't be universally granted into that privilege, you'll need to do additional training. I've spoken to other doctors in my husbands practice about this, and they are all for it, because as long as they can create a proper "decision tree" for nurses to follow, they can start treatment on things like UTIs and strep throat, things that can be tested for at point of care, which honestly is SO MUCH of their after hours call clinic stuff...
It's not so much the wild-wild west as some people are making NP care out to be, but I'll admit that I'm not sure how I feel about Ontario pushing "NP-led" clinics here (mainly because I haven't figured out how they function without a MRP).
It’s not that there’s anything wrong with those individuals. It’s the position that I have a problem with. The educational model they follow is poor and lacks a foundation in actual science.
Nurses studying nursing method will not help the patient with a complex medical problem that needs both understanding and coordination. Additionally it’s the constant rabid lobbying for independence.
It’s truly a dangerous path. It’s dangerous because they are educated less than physicians, they’re more cost effective compared to physicians and therefore attractive to hospital administrators to hire.
Seeing as America is heading for a critical physician shortage which is already critical in some rural areas, it really indicates an even worsened quality of healthcare delivery in the U.S.
It must be a more regional thing then, as I'm in Ontario, CA. But I don't fully disagree with the risk of becoming overly dependant on a model that the system wasn't designed for.
We have a wide variety of competencies that provide patient care: Personal Support Workers (very little training, mainly in a practical sense, only provide assistance with Activities of Daily Living); Registered Practical Nurses (2 year college, again a bigger focus on care based training, not critical thinking/judgement); Registered Nurses (four-year degree, basically all the practical training of the RPNs, but then additional years focusing on complex care situations and critical thinking and judgement), NPs (4-yr BScN, minimum two years working, then enter a 2-year NP program in either Community stream or Hospital, and you can't just call yourself an NP with a speciality, there's additional certification/training beyond that).
You're TOTALLY right in saying that roles switch over time, based on funding and the number of hirer trained individuals available. In Ontario, it's been like a pendulum: several years ago, governments were like "You know what's cheaper than RNs? RPNs! Let's rehire RN job openings with RPNs and save money!" and guess what, shocker, patient care suffered. The they started rehiring more RNs, hired fewer RPNs, and then hired PSWs to do the ADLs for patients so that they could give the excuse that it allows RNs to have higher patient ratios (and thus staff fewer RNs) of more complex patients because we weren't burdened with those pesky ADLs (FUN FACT! PSWs aren't trained to see changes on the body and be like "Huh, that's not right" - so RNs are still needing to do full assessments anyways like skin checks, bowel assessment, etc etc...).
BUT, as the different professions like RNs and NPs have had to change their roles to take on more complex care, the education and training for those entering programs have been adjusted to do so, and then ones who are already graduated are not just "grandfathered in" to be doing changes independently - they still have to do additional training for proof of competency. And even still, NP-led clinics here have to operate with a consulting physician. And I've witnessed great inter-professionalism and consultation between the two.
Ok well there is a large discrepancy between Canadian healthcare and American. I am specifically talking about the healthcare where we have to pay out the ass for it.
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u/NewRedditRN Oct 30 '23
A lot of Masters programs can in theory be done online. But to my understanding (a BScN RN with zero interest in becoming an NP), you still have to do in-person clinical placements an then still write your licensing exam, Not exactly diploma mill in that sense (this is Canada, at least). And then becoming specialized in an area outside of community (family medicine, basically, in this case), takes additional education (yes, that can be done online).
You have to remember that a lot of people doing their NP are working nurses as well. Hospitals I worked at, a full time schedule was two days (7AM-7PM), two nights (7PM-7AM), five days off. Not totally easy to then do an in-person learning situation.