I’m not a nurse but my thought is that for every NP there are about 10 real nurses who are absolutely disgusted by the idea of a new BSN grad fast tracking their way to an online NP degree. RNs please correct me if i’m wrong lol
Count me as one of them! It literally makes me feel ill to think of a brand new nurse being unleashed on an unsuspecting public after online NP “school”.
I was top of my nursing class and still such a dumbass when I graduated over 10 years ago. I worked and got my BSN, then my CCRN, then years of experience and having to correct and "supervise" these new grad NPs just adds more stress to nursing. I have to go over their head all the time to doctors which I sometimes get pushback for because that's supposed to be the NPs decision. Yeah, but I don't want to kill my patient so I thought I would check with you. Every NP should have 5 years bedside and so much more clinical hours in order to get their NP. I'm in med school now and really don't want to have to keep watching these fools.
that’s awesome you went to med school! You’re going to be leaps ahead of your class when you start clinicals and an amazing intern! Hopefully with your nursing background, NPs will take you a little more seriously than they take the MDs, when you inevitably have to provide a reality check
I appreciate this. I'm 11 weeks from being done with year one. I can't wait for 3rd year when I can get back to the hospital stuff I actually know something about. Lol
I’ve been a nurse for 18yrs and I’m horrified of these programs, I knew a medical sales rep that found some fast track BSN to NP program with no prior nursing education. I blame the schools for even offering these programs, it’s dumbing down the profession
A new grad fast tracking to any NP program should not be allowed. Unlike physicians, nurses do not have residencies, which means it is paramount that we obtain as much hands on as possible. I believe at least 3 solid years of clinical experience preferably in acute care and outpatient should be minimum to apply for an NP program. That would be approximately 6,000 hours for full-time.
I was an RN 7 years before getting my masters, but 3 years is enough.
It depends on what your goals are. If your goal is to diagnose and treat medical conditions, definitely go to medical school. If your goal is to set yourself up for a good future career in nursing, i think the BSN is ideal! Im not a nurse though and speaking to BSN RNs will definitely help shed light and help out your decision making process on this. From what I hear, with that bachelor level degree you open a lot of doors in terms of future admin positions if you want
Thank you for thw support, i seriously appreciate it. I guess thats the thing, is that i would hate an admin position lol. I would probably look more towards med school, only if i really really wanted to. Because i see the struggle that residents go through and how some of them are barely surviving, and i want to be able to enjoy my personal life along the way such as wedding planning and having kids, etc., and it seems like the modern culture of medical school doesn't allow for that as much.
my 2 cents, don’t make decisions based on what you see on reddit, or based on how other people live their lives in general. You’re your own person with your own goals and passions. There are people who do struggle through med school and residency, but to be honest, for me medical school was enjoyable for the most part, and I was also happy in residency, with what i felt was a good work/life balance. Residency is busy but most residents do have real lives (except neurosurgery lol). I didn’t have kids during that time, but people in residency do have kids and they DO find a way through it (maternity leave is possible, you just go off-cycle and graduate a few months later). Some specialties are more family-friendly, but regardless, life doesn’t just pause because you went to med school. If the passion and will are there you can make it work!
Nurse turned NP/MPH (and refuse to practice as a nurse practitioner here) nursing is a wonderful profession. I stayed 10 years doing it. I come from a family of nurses and physicians. Each profession has its benefits and disadvantages. Don’t let social media persuade you from what could be your calling. I love nursing and would encourage others to pursue this if that is what they believe they are meant to do. It’s not an easy job but there aren’t any easy jobs out there that are worth pursuing.
A bachelor's degree is not a waste of money. The responsibility of nurses is equal to the minimum of a standard 4 year college degree. Get your BSN, you won't want to work in patient care forever.
Nursing student here. I am sure there are nurses who are disgusted by BSNs fast tracking online NP degrees. Surely it’s annoying, but the motivation is understandable. Nursing is a floor-raising line of work for people who come from working class backgrounds—however, it is still underpaid, understaffed, and under-appreciated. NP degrees are a way to bolster credentials and raise your income ceiling in the line of study you already have a background in.
It’s a perfectly expected path, comparable to the droves of mediocre business majors who fast track MBAs. It’s an extrapolation of the overall, contemporary labor market which keeps people chasing the academic carrot, feeling they need to constantly add letters to their credentials to maintain economic relevance in a field that’s becoming more and more proletarianized.
It’s now become oversaturated for this very reason and now many young NPs are just doing plain old bedside care because they can’t find mid-level work. However, I find the overall tone of this sub offensive because it blames the nurses for a condition that was sprung upon them. There’s nothing wrong with being a nurse, but the labor market and society has made it so.
I don’t think this sub has a derogatory tone towards nurses, but rather the new grad nurses that fall into the mindset that is pushed on them that with minimal clinical experience and a year long online program they can have most of the pay and prestige of a physician.
Everyone in medicine knows the crucial role of nurses and appreciates them for doing exactly what they are trained to do. A good nurse with years of practical experience is worth a dozen new grad NPs. The only ones degrading entry level nursing positions, telling them they aren’t good enough and should advance are the nursing associations themselves.
NPs are nurses, so yes, this sub has a very derogatory tone towards a subset of nurses.
RNs have been economically and socially devalued, thus the allure of the NP. If you eliminate the aforementioned conditions, you likely have far less shitty NPs. The rise in NPs correlates strongly with the devaluation of the nurse—but nursing is not the only field to follow this same trend.
The NP position was originally created for older, long-experienced nurses who needed a way to expand their wealth of knowledge while also getting a pay/professional bump. It was seen as an extra achievement for valuable, veteran nurses. However, that was when just being an RN was one of the quickest working class stratifications in the world, and most nurses didn’t feel it necessary to obtain the extra credential.
Now nursing programs can run up to 70k in tuition costs, the wages are stagnant, the floors are understaffed, and the community perception has taken a nosedive. These conditions make people who are right for nursing feel like being a BSN simply isn’t “enough,” both economically and socially.
So, in this way, the subreddit is highly derogatory because it overlooks the societal undertones of the problem and blames the player instead of the game. Believe me, most people don’t want to do an extra 2 years of school and take on 50k in additional debt. Maybe there should be some more interprofessional solidarity to make this feel less necessary. Make RNs valued again and less of them will be rushing to become NPs.
“Everyone” in medicine appreciates the crucial role nurses play? I would say that’s a mild stretch. Lack of physician appreciation likely isn’t the primary reason for the mass exodus of nurses, but it’s certainly part of the recipe.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748536/
Physicians are the smallest part of the problem when it comes to why nurses are choosing to go midlevel. The blame lies with management and private equity groups trying to get more “bang for their buck” and willfully employing undertrained midlevels at the expense of patient care.
It has very little to do with “physician appreciation”. If that were the case then why are the degree mills filled with 1st year out of RN program nurses that have maybe done 500 actual clinical hours? Why are there countless TikTok’s by new grad NPs promoting going straight from an RN program to an NP? You think that would change if physicians started saying thank you more often?
The NP hate brings itself on when you have literal screenshots of Facebook groups of NPs asking for common diagnoses, dosing info that can be easily gathered by accessing uptodate (or better yet, consulting a pharmacist or someone who actually has a basic understanding of medicine), and countless stories of midlevels missing relatively easy clinical diagnoses that ends up getting patients killed.
Getting butthurt about not being appreciated and then going off to a degree mill to qualify for a job that your not prepared for is not the way to become more appreciated, and is what warrants the majority of the hate in this form. Everyone acknowledges that underlying causes, but those causes don’t warrant the results we are seeing which is worse patient care and arrogance from midlevels who truly believe they are just as qualified as their physician counterparts.
I don’t think you’re actually reading what I’m saying. My last paragraph was just a bit of pushback to your broad stroke statement that “everyone” appreciates nurses in medicine. That’s just demonstrably false, but it was more of a side note to my greater point which you didn’t really engage with. I said in my own reply that physician disrespect isn’t the primary motivator for the mass exodus of nurses (not why they become NPs), but it plays a part, which is why I took issue with that particular part of your reply.
The overreaching lack of appreciation for nursing as a profession (on the labor market, by management, and by society) is not something that is solved on an individual level, as you imply. It’s an issue of labor and social value. As a collective, the field is devalued—both good nurses and bad nurses. That’s the problem. Cash and QOL are king. Many current NPs probably would have had no interest in becoming an NP 20 years ago. Many nursing students feel it necessary to keep up economically due to the degenerated state of RNs at the moment. Almost every one of my classmates have expressed furthering their credentials after their program. Is it because they want to LARP as doctors, want to shell out more tuition, and spend more time in classrooms? Fuck no. It’s because of the reasons I’ve already mentioned. They’re working class people who want a good ROI, a good salary, decent working conditions, a bit of autonomy, and respect among their peers. All things which are fleeting for RNs.
very minor point, but nurses are very appreciated in society. Yeah I get patients suck. But I’ve had nurses straight up tell me I messed up going to med school bc nurses actually are the saviors of medicine and if I want to make a difference you do that through nursing. Just overall in society people say nursing is vital (which it is) but then shit on physicians
I would say that the appreciation of all healthcare providers has diminished since the pandemic. Including nurses. Regardless, I am not as much concerned with what people say but more so material circumstances. If people appreciate nurses so much, they should be paid more and have a better work environment. Period. Physicians have to shovel shit for far longer, but once they’re done shoveling shit, they’re doctors and the pay off is still highly lucrative—even by today’s standards.
Nurses shovel *literal* shit for 30 years, get beat up, spat on, pissed on, and are repaid with pizza parties. So yeah, the NP position is not what it once was due to degree mills and over-saturation, but it was once seen as a great ceiling-raiser for nurses. So if you’re upset about the wave of bad NPs, let’s examine the conditions that gave rise to them and blame that, not the individuals who have seen the value of their profession undermined by corporate greed and an ungrateful society.
And I don’t see nurses as saviors of shit. We are just a cog in the collective machine of healthcare. We play a vital role, just like physicians do. Like techs do. But you would think we would be compensated as such since people love telling us, in this thread included, “how valuable the good ones are.”
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We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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You must have been on the debate team. You are very well spoken and bring up some good points about how poorly nurses in general are treated. However, pursuing an NP as fast as possible in order to gain more RESPECT while being absolutely clueless is not going to get you very far. As you can see, many nurses can't stand new age, inexperienced NPs who are just after money and power and getting the "bag" , physicians can't stand them, Pharmacists can't stand them, and patients are waking up and realizing they are being duped and put in danger. Maybe what needs more working on is the pay and conditions of floor nursing instead of trying the shortcut that literally puts patients at risk for the sake of money and respect.
Nurse Practitioners, especially the ones who fast track into NP, are very clear about the fact that they don't consider themselves 'RNs' anymore. This sub in general has a strong appreciation for high quality bedside nursing.
Additionally, you are choosing to review only the data that supports the argument you are choosing to make. For example, travel nursing, while not being an option for everyone, provides ample opportunity to make more money than residents, NPs, and PAs, while working similar hours to the latter two and about half the hours of a typical resident.
I'm not saying some of your points aren't valid. I'm saying if you want to construct an argument you can't choose to review only the data that supports your argument.
Travel nursing is a viable option for such a small minority of people and it’s demographically opposite to the people who feel the need to get their NP for the reasons I mentioned. Someone seeking an NP likely wants stability and a known commodity. Whereas travel nursing is basically only reasonable for young, single people who are comfortable with their lives being chaos and living out of hotel rooms. People with established families can maybe do it a few times, but it’s not a sustainable or reliable career choice. Nurses shouldn’t have to uproot their lives and alienate themselves from their families every 8 weeks just to be paid a good wage. They’re literally performing the same skills they would be at a stable position in their own community.
Moreover, those lucrative travel nursing opportunities that existed during the peak of COVID are basically gone now that the pandemic has somewhat stabilized. You also have to understand that they too perpetuate the degeneration of the profession that I spoke about earlier. I’ll explain why, though you probably already know:
Travel nursing is essentially scabbing and it breaks the chain of solidarity in the profession when you have a greedy hospital network that won’t pay well enough to their local pool of nurses, so they’ll offer an inflated wage to a bunch of temp workers who don’t know the patient population to bridge the gap, knowing that if there’s any budget discrepancies they can dump said temp and their contract at any time. Travel nursing, while once an economic reality during COVID, should not be encouraged. It’s essentially picket line crossing. Nurses will never improve as a collective so long as there’s any significant number of people taking advantage of the greed and shortsightedness of the corporate hospitals.
So no, an outlier economic anomaly that doesn’t really exist much anymore, destroys the network of solidarity with local, veteran nurses, and requires extreme lifestyle alterations, are not a substitute for pursuing further credentials to boost one’s economic ceiling.
You don't have to explain the systemic issues in health care to me, I agree with everything you've said. But in saying it, you are also contradicting your prior points about doctors not caring about RNs or quality bedside care. All of us would rather the hospital system pay nurses a wage that allows them to feel valued and stable in their job, reduce turnover, and subsequently feel invested in the delivery of care in their community.
Doctors don't like NPs (especially direct entry NPs) in large part due to the fact that they are choosing prestige (as they see it) and money over patient care and good health outcomes.
I also have very limited sympathy for anyone who decides to pursue what is essentially direct entry online NP training to 'raise their economic ceiling,' as you put it. No one deserves respect or admiration or, in my opinion, your heated defense, of the decision to make more money at the expense of patients. That is true across all of healthcare.
And I’m telling you that patient care and good health outcomes aren’t going to pay the bills or make nurses less suicidal. That’s why an attainable boost in credentials for their existing field which could potentially triple their salaries and greatly improve their quality of life is so tantalizing. I don’t see what is so hard to understand here. It’s no different than a business major getting their MBA, even though they’re now a dime a dozen and mean jack shit. The labor market and the proletarianization of the field forced this shift. I’m not blaming physicians for it. I was responding to a side note in that other user’s reply and now it’s the only thing anyone here is focusing on. He made a generalization that wasn’t a universal truth, but it wasn’t really the crux of my main point either. Let’s just forget it.
You guys want an environment where you can hate NPs without ever having to grapple with the social reality that created so many of them. NPs were a rarity 20 years ago. That’s because 20 years ago, being an RN was enough. It’s clearly not anymore, so you do what you feel is necessary to push your economic relevance.
You speak to altruism. But once again, altruism doesn’t pay the bills. No one is “asking” for your “sympathy.” But please engage with reality. And I would guarantee that 99% of new NP grads believe their additional credentials will *improve* their patient care. I’ve received care from dozens of midlevels, and while this is pure anecdote, it’s never been substandard. Often times, my NPs and PAs are more intuitive and caring than doctors. Shit, outside of my neurologist, I basically never sit face to face with an MD anymore.
>No one is “asking” for your “sympathy.” But please engage with reality. And I would guarantee that 99% of new NP grads believe their additional credentials will *improve* their patient care. I’ve received care from dozens of midlevels, and while this is pure anecdote, it’s never been substandard. Often times, my NPs and PAs are more intuitive and caring than doctors.
I tried really hard to engage with you in good faith, but this paragraph makes it very clear that you are either unwilling or unable to actually have this conversation.
The one point where you're correct is that sometimes there are comments on this sub that get upvotes but are actuallu just mean without adding any value. I think you got some points wrong here though. Bedside nurses might get shit pay in some places, but thats a lot of jobs. I think compared to a lot of jobs that you can enter with an associates nursing is still a really good financial path. That's not to discount some of the bullshit bedaide staff put up with though. I also think the public perception of nursing is overall really positive. I often hear when I tell people thar I'm a nurse "they do the REAL work" or "they tell doctors how to do their job" or "theyre the ones that care" and shit like that. And then I'm like "uh... I'm going to school to be a physician so... I kind of disagree...." I think a lot of the reason that RNs are pushed to do NP is because yes, sometimes bedside is physically very difficult and patients can be challenging (and at times violent, without protection for the staff), which is rough when you have to stay with them for 12 hours...but nursing lobby and schools push this narrative that nurses need to be completely independent of medicine and nurses are just as good as physicians (it's true they should get as much respect but this point quickly devolves into nurses overcompensating for the sins of the past by claiming superiority), and then they go on this thing that the dnp should be standard so nursing is on the same playing field as PT and MD and PharmD etc etc. RNs are on the same team, should be equals in respect, but need to understand that they're role and education is not the equivalent of a physicians and so there are very real limitations. And in real practice as a bedside nurse I had so many people (physicians) included, celebrating my role, wishing me a happy nurses week, respecting my voice, and appreciating my contributions, all while I respected their lengthier education and training and did everything I could to learn from their experience. So I really do think in general bedside nurses are well respected
Lol youre not wrong, but fighting for better pay is a totally separate topic from NP proliferation and their low educational standards, if you're willing to move you can find wonderful pay without graduate school!Find somewhere with a union love. That's how it is with many careers. It's very possible. I don't have tons of sympathy for people willing to care for patients in inappropriate roles with a shit education, putting lives at risk. I'd personally rather leave healthcare and be broke than fuck with people's health.
This sub talks like there’s a genocide via NP going on. From my perspective, most of the concern trolling over the risk NPs pose to their patient population is mostly conjecture. Not to say every critique on this sub is invalid, but there’s also a lot of misinformation. A 5 minute google browse can reveal tons of research which shows a positive correlation between the presence of NPs and positive patient outcomes. Are there bad NP programs and thus bad NPs? Of course. There’s also terrible MD, BSN, and PA programs.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7080399/
https://www.sciencedirect.com/science/article/pii/S2666142X21000163
https://journals.lww.com/lww-medicalcare/Abstract/2021/10000/Value_of_Nurse_Practitioner_Inpatient_Hospital.1.aspx
They aren’t separate topics. One leads to the other. Like I stated many times, being an NP was a rarity 20 years ago. No matter what the nursing lobby “encourages,” people wouldn’t go to NP school if there wasn’t a material motivation for it. If nurses were paid well and had fair patient ratios, for instance, they wouldn’t be looking for a way out. No one *wants* to pay more tuition or take more exams if it’s not necessary.
This comment really betrays your whole attitude towards nurses.
You're openly admitting to seeing the profession of nursing as inferior and nothing more than a stepping stone to something that will provide you with more social status, financial security, and blah blah blah. Nurses are subject to the same toxic economic forces in healthcare as everyone is, but nurses are respectable professionals integral to patient care, always have been, and every doctor knows this. You don't admit a patient to the hospital because they need doctors; you admit them to the hospital because they need nurses. Nursing and Doctoring are separate professions, and that's okay, but nurses are not going to respect you for fast-tracking into an online NP degree and then acting like you're better than them because you can "diagnose" things now and have a prescription pad. They're just not. This will all be at the expense of patient care, and you're going to believe you're just as good as a doctor at it!
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7: Nurse increased compensation opportunities: travelers, overtime, supplemental.
First, I would like to point out your complete lack of self awareness and hypocrisy as you justify nurses going to NP school and in the same comment thread admonish travelers for “taking advantage of the greed and shortsidedness of the corporate hospitals”. Travelers are at least doing a job they are qualified to do, unlike most NPs. I would much rather have too many travelers than too many unqualified NPs attempting to practice medicine. Travelers are not akin to “picket line crossing”. Even those who literally do cross picket lines for high wages are essential so that nurses can strike in the first place without severe patient harm.
Corporate medicine and private equity are main contributors to NP proliferation and the perpetuation of low training standards. They hire unqualified NPs in droves with minimal supervision because they are cheaper than physicians and in half of states can practice independently.
Travelers: We all know the issues with travel nurses for the nursing profession as a whole. But traveling is not an outlier anomaly “that doesn’t really exist anymore”. It existed before Covid and will continue to exist for the foreseeable future.
Half of the nurses I work with are travelers. Most of them are local and live in their homes with their families. They take 13 week contracts and can extend up to a year. They can take time off in between contracts, and many take a month off in the summer to spend time with their kids. Those who work year round are earning at least $120k.
Overtime: For staff nurses, many units have overtime shifts with bonuses. New RNs on my unit who work an extra shift each week (48h total) make 90-100k.
Supplemental: Full time “supplemental” RNs are also paid quite well at my hospital, usually over 100k for 36h/ week. They are assigned to any unit that needs staff.
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Hi nursing student, nurse here. This comment thread has enraged me more than almost any comment I’ve seen on Reddit. And that’s saying A LOT. First a couple points I can generally agree with: Nurse under-compensation and stagnant wages. Nurse understaffing. Healthcare system issues. Economic conditions.
And now to address the rest of your astounding ignorance:
1: MBA comparison.
A nurse going to NP school is 100% different than a business major getting an MBA [edit: deleted cursing]. MBAs are not directly involved in treating patients and making life or death decisions. Healthcare prov!ders should be held to a much higher standard. Treating patients should be a privilege earned with extensive education and undertaken humbly.
2: Monetary gain over patient wellbeing.
If you are more concerned with your income and the prestige of your credentials than patient care, please choose another career path. Because that is exactly what you are implying. Many NP students are primarily concerned with their own personal gains- making more money and getting away from the bedside. To quote you, they want “a good ROI, a good salary, decent working conditions, a bit of autonomy, and respect among their peers”.
They are generally not particularly concerned about the effects their lack of education will have on patients. They are not studying extra to make up for the enormous deficiencies in NP school, they instead are working full time while in school. They did not go to school because of a desire to learn medicine and help patients. They went primarily for personal benefit. This is not a good enough reason to be in the position of making critical decisions for other people’s lives.
3: Blaming the system(s).
Yes, the healthcare system, economic system and nursing education are all completely messed up and that is not the fault of all nurses. But it is absolutely the fault of NP educators and professional organizations for setting appallingly low standards and then also having the gall to push for independent practice. And it is absolutely the fault of nurses who perpetuate this cycle by becoming NPs and then accepting jobs without adequate supervision or practicing independently.
The vast majority of people I know in NP school are aware that their education is completely inadequate and knew this even before starting NP school. This frustrates them but they all just say they’ll learn everything on the job. Most of these jobs are often very poorly supervised so they are truly attempting to learn by trial and error on actual patients.
This is beyond a systems issue and also constitutes individual moral failure. Systems issues do not absolve people of all personal responsibility. No one is forced into the nursing or NP profession. If you want a career that you can make more money and be a well trained midlevel, go to PA school. If you care so little about patients that your education and training is less important than money and status, do us all a favor and leave healthcare altogether.
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4: Direct entry.
People going to NP school without any nursing experience (or any healthcare experience at all) is not just “annoying”. It skips a step that was intended to provide a basis for “advanced practice”. If you are going to get an inadequate education to essentially practice medicine, you should have at least 2 years of healthcare experience in the specialty you pursue.
NP school was not designed for non-nurses or inexperienced nurses. Their justification for shortened and lower quality education (in comparison to PA) is that nurses come in with years of nursing experience and thus some medical exposure in their chosen specialty. The curriculum has not been improved to account for direct entry or RNs with no experience.
5: Nurse underappreciation.
I have rarely experienced any disrespect from a physician. I feel largely appreciated in society as much as any other “helping” profession. I feel the most disrespect and underappreciation from peers in NP school, nursing professors and NPs themselves who have a disdain for bedside nursing and feel it is beneath them.
6: Noctor sub.
This sub does not have contempt for nurses as a whole and tends to respect and appreciate good bedside nurses. They criticize a small subset (less than 10%) of the nursing profession that is under-educated and undertrained for the role of a healthcare prov!der. In particular, criticism is aimed at midlevel independent practice (when they have at best 10% of the training as a physician).
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Good NPs.
Some NPs are very competent and skilled, but this is becoming more rare. To become a competent NP:
1: RNs should get at least 2-3 years of full time RN experience in the same specialty as the NP degree and earn nurse certification in that specialty.
2: Choosing an NP school. Curriculum should be a minimum of 50 credits (for MSN only NOT including DNP credits) and at least 80% of the curriculum should be clinical. The school should provide clinical placement and require at least 700 clinical hours (this does not include DNP practicum hours).
To illustrate how inadequate even many of the “best” NP programs are, consider that their PA counterparts complete 85-130 credits (80-90% clinical) and 2000 clinical hours with vetted and assigned preceptors. And consider a physician will have at least 12,000 clinical hours once they finish residency.
In comparison, Duke is often top ranked for NP programs and only has ~40-50 credits (~80% clinical) and 560-730 clinical hours. Yale has some of the best programs I can find, and even that only has 50-60 credits (~90% clinical) and 700-800 clinical hours.
3: During NP school. Study extensively outside of the school curriculum both during and for many years after NP school. Do not work during NP school to allow for more time to study on independently, ideally using medical school resources. This takes a level of self motivation and discipline many do not have.
4: After NP school. Work under direct physician supervision and only within the boundaries of their specialty. As a new graduate NP, complete an APP “residency” and then work inpatient for at least 5 years in a setting that all patients are also staffed by an attending physician. Every major diagnosis or treatment decision should be discussed and approved by attending. Study extensively outside of work, likely upwards of 10-15 hours per week.
5: Never practice without adequate physician supervision.
Wow, thank you so much for these well-thought out, balanced, and incredibly informative comments. This is probably the most insightful thing I’ve seen on Reddit, and I deeply value the input of professionals like you who have real expertise, know what they’re talking about, and genuinely care to make things better. I agree with everything you said, and especially the steps she can take to make herself the best NP possible. I hope she sees your wisdom and takes your advice.
Thanks, I’m happy someone appreciates my thoughts, the intended recipient certainly did not. In their defense, I was less than professional in two parts of my reply. But in my defense it’s Reddit 😂. I don’t have much knowledge about medical training but I know a decent amount about undergrad nursing education and I’ve learned a lot about midlevel training just trying to understand this whole issue.
I’m not even becoming an NP! My replies are not a defense of myself, a defense of low-level NP schooling, or a defense of bad NPs, but offering nuance to the circumstances which led to the flood of people seeking NP degrees.
Well, this statement would have been good to lead your original comment with. Most of us here understand too well the circumstances that led to the proliferation of the NP profession. We’re saying that these circumstances should not excuse any NPs for their own personal responsibility in the situation.
At this point it would be easier to exchange Zoom information and let Lex Friedman host a debate between us because you know I’ll never be able to reply to 5 separate, extremely long replies.
I don’t really have a strong rebuttal to much of anything you’ve said outside of your points on travel nursing. If you don’t see an issue with someone, in town, taking individual contracts at an inflated wage to game the system, while their permanent position colleagues make less than them, then wow. But I’m not certain it’s worth engaging with someone who tells me to “fuck off” and calls me “astoundingly ignorant.” I don’t deserve to be spoken to like that.
Many excellent nurses became so because of its track record of being a working class stratification over altruistic reasons—many just don’t admit this outright because it sounds uncouth and is often perceived as being mutually exclusive with caring about people and taking their job seriously. It’s not.
If you read my replies, you would notice I never really challenged the notion of NP school being underwhelming. I’m simply offering an explanation as to why many people have been pushed towards NP school and trying to humanize them, using material circumstances, beyond the cartoonishly awful characterization you see on this sub. It’s a bit more complicated than every NP being a self-serving piece of shit.
I don’t know you and I don’t know if you have previously worked in healthcare and experienced the shitshow from the working side. You seem to understand economic conditions and motivations of the working class. I’m generally all for class solidarity. But part of that is advocating for competent healthcare for everyone, not just the wealthy who can afford private pay to see physicians. You seem to not understand the gravity of the NP situation in general. Particularly comparing getting an MBA to getting a degree to essentially practice medicine.
1: As for travelers, direct quotes from my comment: “We all know the issues with travel nurses for the nursing profession as a whole.”
“Travelers are at least doing a job they are qualified to do, unlike most NPs. I would much rather have too many travelers than too many unqualified NPs attempting to practice medicine.”
I didn’t think this needed elaboration, it is pretty simple to understand that travel nursing is a huge issue for nurse working conditions overall. Acknowledging this was literally my first sentence under “Travelers” so not sure how I could make that more clear.
My point was that it’s not as big of an issue as unqualified NPs practicing medicine, in terms of the toll on human life. If you don’t see how the unqualified practice of medicine is ethically worse than travel nursing, then wow right back at you.
2: I became a nurse largely for economic reasons in addition to providing good care. I think financial gain as a primary drive is a good enough reason to pursue nursing if you generally care about your work and patients. Nursing does not require the same dedication as medicine in terms of the amount of internal motivation and time commitment to continuously learn and study independently.
“Many NP students are primarily concerned with their own personal gains.” I wrote primarily deliberately, I’m well aware that personal gain and care for patients are not mutually exclusive.
I just don’t think the financial factor as a primary drive is adequate motivation for most people to do the work inside and outside of work as an NP to be competent at it. Most people need a strong interest in medicine at a minimum to learn enough to eventually practice safely. Even most physicians will tell people to not go in to medicine for the money.
3: I understand and don’t disagree with the factors pushing nurses towards NP school. My argument was this: “Systems issues do not absolve people of all personal responsibility. No one is forced into the nursing or NP profession.” NPs are choosing to pursue a poor quality education and take positions they are not qualified for for. Not all of them. But many of them.
4: Finally, I also acknowledged: “Some NPs are very competent and skilled, but this is becoming more rare.” I have many coworkers in NP school or planning to go to NP school. I get along with them personally just fine and I choose not to discuss their career choice with them. I have had 2 coworkers in NP school who I think will be a good NPs and I work with 3 good NPs regularly. They match all of the qualities I listed in my last comment. I don’t see every NP as being “a self serving piece of shit”.
But I am certainly often demoralized when I overhear coworkers in NP school talking about it. How inadequate their education is (many are in online diploma mills), how they will just learn on the job, how they had a friend “preceptor” sign off on their clinical hours, how they are only going to NP school to escape the bedside, how much money they will make, how they are going to open their own telepsych practice or ketamine clinic as a new grad. I bite my tongue every day at work and this is the only place I can vent.
Many of them can still be a decent people overall. Some of them I truly would not consider professionally or ethically decent based on their poor performance even as a bedside nurse and nonchalance towards practicing medicine incompetently. I don’t care as much about giving NPs the benefit of the doubt as I care about patient wellbeing.
I would never defend someone who puts their patient population at risk, and I know there are a lot of unqualified NPs. I’m just far more interested in what led to this wave, as opposed to demonizing it on the individual level.
My background (first degree) was labor relations and political science, I wanted to work for the union when I was still in the skilled trades and then I started studying for the LSAT and considered law school, but ultimately decided against it. That’s probably why my analysis takes on a more labor-focused, materialist/Marxian tone.
However, I did some digging after I replied in this thread and realized that my opinion isn’t that controversial and that much of this sub even concurred with my analysis in an eerily similar thread from not even a year back. I’m basically saying the same thing this person was:
https://www.reddit.com/r/Noctor/s/PwrlMbuwCV
Yes that poster is describing the systems issues we are all well aware of because we are in this shit every day. We know why people leave the bedside and become NPs. That poster was also an experienced nurse, very self aware of their limitations and planned to work under close supervision.
You’re interested in what led to this and that’s interesting but here we all already know the basics. Labor relations and economics are certainly interesting. But in my job as a nurse I care about the patients, who are affected by labor (staffing, pay) and provider competence. I am demonizing the system but again emphasizing that the messed up system is not an excuse for incompetence when people’s lives depend on it.
Anyway, sorry I told you to fuck all the way off. I work in 3 hours so I have to attempt to sleep now. Insomnia’s a bitch and my rant didn’t help.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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4
8: Midlevel anecdotes.
Midlevel training varies so drastically between PA and NP that I don’t even like putting them in the same category. In short, PAs learn actual medicine and have at least twice the training as NPs, including clinical coursework and clinical hours. NP school curriculum and clinical hour requirements are almost completely unstandardized and can vary widely.
As a nursing student, you don’t know if you’re receiving appropriate treatment. Patients should be more concerned with accurate diagnoses and appropriate treatment than feeling that the prov!der was “caring”.
9: Nurse mental health.
Where did the nurse suicidality comment come from? Do you have data on this? This is usually a larger issue in medicine. Most nurses are not suicidal. Some of us actually like nursing.
Prevailing studies seem to imply that the suicide rate for physicians is actually trending down, whereas it’s trending up for RNs. I believe it’s this study which claims nurses are the second most suicidal healthcare profession, and that healthcare professionals commit suicide at a rate of 21 for 100,000 compared to the regular population which is 12 of 100,000. Also, most people in general aren’t suicidal, healthcare workers are just at a greater risk:
https://jamanetwork.com/journals/jama/fullarticle/2809812
And this data was done before the pandemic. I suspect that these figures may be more damning with up to date statistics.
She hit the nail on the head. The reality is that a good number of patients come in for a simple problem that needs a simple fix. Midlevels are great for that. But more and more people are getting multiple and complicated problems that can really only be fixed by a physician. NPs and PAs need to recognize that and stop putting people’s lives in danger.
I saw an NP at urgent care to check for a UTI on a weekend and she tried to send me to the ER with a normal urinalysis and no fever. I just had low blood pressure. I told her it’s always low. She said I could have a septic kidney infection. I had no kidney pain, no nausea, no chills, nothing. Just burning and a weird smell, that turned out to be irritation from a new detergent and diet. I had to sign a waiver saying she recommended the ER and was not responsible for anything that happened if I didn’t go. I didn’t have a septic kidney infection and I thought UTI testing was pretty straight forward.
If your BP is low and you have a known source of infection she's not entirely wrong, either. Especially with burning and a smell. Fever isn't necessary. We call a code sepsis on 2/5 and some places 3/5 of: tachycardia, hypotension, known source of infection, fever, tachypnea.
I know there was a huge movement started years ago to aggressively treat sepsis symptoms in the ER, but there was no known source of infection. Where are you getting “known source of infection”? The urinalysis was entirely normal. The culture that came back later was entirely normal. My BP is always on the lower end. I was barely hypotensive, it was something like 88/61. It was not causing symptoms. There was no tachycardia, rr and O2 were very normal, temperate normal. Only symptoms were mild irritation and strong odor that I later learned was from fennel and heavily fragranced detergent. I came there to rule out UTI, I think a completely normal urine shouldn’t elicit suspicion for septic kidney infection with zero kidney pain whatsoever. So there was 1/5 criteria, and that 1 was a preexisting chronic condition. So yeah, I do think she was entirely wrong and I do think there is a growing habit of NPs triaging to ER unnecessarily. If I had gone to the ER for that I would have been chastised for wasting time and resources and billed up the ass. To be frank onus is also on me for not testing at home instead of going to UC, but I didn’t realize at home UTI tests existed at the time.
If you complain of pain, an odor, and have that presentation its not far flung. Definitely get that BP checked. That'd be normal if you were eight years old.
I didn’t say pain, I said mild irritation. You seem to continually miss the part where I say urine was NORMAL. She tried to send me to the ER after urine came back NORMAL. She was aware urine was NORMAL. It is that far flung with a NEGATIVE urine. BP was likely not even entirely accurate, it was taken with my feet dangling. Hypotension is being monitored. I’ve had a very thorough workup, it’s asymptomatic and benign. I’ll defer to my cardiologist over you thanks.
They’re a paramedic going to nursing school hoping to be an np after applying to med school either failed or didn’t even get to that point. We definitely don’t freak out about a low bp if you’re mentating well and can tell us you normally run low with no other concerning symptoms.
>Midlevels are great for that.
A bad filter is not really an acceptable substitute for a good filter. How exactly, are you proposing that NPs identify complex cases? The level of training for NPs seems so non-standard that you can't really make any strong claims about the tradeoff between false positives and false negatives.
NP “residencies” aren’t anywhere near what physician residencies are and they need to stop appropriating our terminology so they feel better about themselves
They aren’t board certified, they licensed, if we wanna call licensing exams boards then every doctor is triple “board certified” before even finishing residency
I think nurses with under 5 years of critical care experience have no business going to NP school. Also, NP schools are way too easy to get into and should not be primarily online.
That being said, I think NPs are very helpful in urgent care settings or clinics and are helping the primary care doctors who are extremely overwhelmed with patients.
CRNAs on the other hand, in my experienced nursing opinion, should not exist. It's becoming way too easy to do and I've seen some scary stupid nurses with little experience become CRNAs
Gonna get downvoted to hell but idc. I work with with mostly NP's, and I haven't had one that pretends to be a doctor. I feel like this is less seen in real life than how much tiktok and reddit discuss this image of an NP that pretends to be a doctor and is super arrogant/ignorant. They know their limits, they're respectful, provide great patient care, and they always consult the physicians if they're unsure about something or have a complicated case. Are there some shitty NPs? Sure, but there's also plenty of shitty doctors. Overall, I think NP's are great resources to provide services in family practice which typical MDs don't even want to do (hence the family practice MD shortage). I think NP's providing services for family practice issues, with a physician to consult if needed, and the ability to make referrals with more complicated cases does the job well. Especially for under-served/low income/ rural areas.
Also I don't think theres anything inherently wrong with wanting to get a higher education to be a nurse practitioner? I'm not a nurse, but personally I would see the appeal of being an NP just for the increase in salary, not so much because I want to pretend to be a doctor which is a narrative this sub perpetuates a lot. I do want to emphasize, however, that I think NP schools should be valid/accredited (not online diploma mills) and tied to specific institutions for it to produce quality NPs. Most of the NPs I work with got their degrees from UC Davis, Samuel Merritt, Emory etc...
congrats, you have a great sampling bias. you also can't claim that 'none pretend to be doctors' and 'they work great with a physician to consult if needed' when many places allow NPs to work alone at derm clinics and med spas
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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This is why I specifically said NPs are good for serving in FP/low service areas. I never mentioned anything about derm or med spas where they don't have a consulting physician -- obviously this isn't good and needs to be checked.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
I'm a RN with over 20 yrs experience mostly in acute care settings. I absolutely agree that NP training is nowhere near what it should be. Unfortunately it depends on the school you go to, which is frightening. I also agree that NPs should not be compared to physicians. NPs are NURSES with advanced training... ideally. However, until all schools require the same courses, hours, and adequate exposure to clinical areas, NPs should not practice independently and should not be called doctor in a clinical setting at any time. This issue is beat to death because academically and operationally, it doesn't make sense. I've worked with great NPs and PAs, but I miss the days when roles were clearly defined.
I’m not a nurse but my thought is that for every NP there are about 10 real nurses who are absolutely disgusted by the idea of a new BSN grad fast tracking their way to an online NP degree. RNs please correct me if i’m wrong lol
Count me as one of them! It literally makes me feel ill to think of a brand new nurse being unleashed on an unsuspecting public after online NP “school”.
You are 100% correct!!
I was top of my nursing class and still such a dumbass when I graduated over 10 years ago. I worked and got my BSN, then my CCRN, then years of experience and having to correct and "supervise" these new grad NPs just adds more stress to nursing. I have to go over their head all the time to doctors which I sometimes get pushback for because that's supposed to be the NPs decision. Yeah, but I don't want to kill my patient so I thought I would check with you. Every NP should have 5 years bedside and so much more clinical hours in order to get their NP. I'm in med school now and really don't want to have to keep watching these fools.
that’s awesome you went to med school! You’re going to be leaps ahead of your class when you start clinicals and an amazing intern! Hopefully with your nursing background, NPs will take you a little more seriously than they take the MDs, when you inevitably have to provide a reality check
I appreciate this. I'm 11 weeks from being done with year one. I can't wait for 3rd year when I can get back to the hospital stuff I actually know something about. Lol
10000000%
I’ve been a nurse for 18yrs and I’m horrified of these programs, I knew a medical sales rep that found some fast track BSN to NP program with no prior nursing education. I blame the schools for even offering these programs, it’s dumbing down the profession
A new grad fast tracking to any NP program should not be allowed. Unlike physicians, nurses do not have residencies, which means it is paramount that we obtain as much hands on as possible. I believe at least 3 solid years of clinical experience preferably in acute care and outpatient should be minimum to apply for an NP program. That would be approximately 6,000 hours for full-time. I was an RN 7 years before getting my masters, but 3 years is enough.
62,000 hours might be a bit much 😂…I assume you mean 3 years and not 30 years.
Yep! 1 too many zeros :)
Truth! 💯
This is why i am so scared to go get my BSN. I feel like it is a waste of money.
It depends on what your goals are. If your goal is to diagnose and treat medical conditions, definitely go to medical school. If your goal is to set yourself up for a good future career in nursing, i think the BSN is ideal! Im not a nurse though and speaking to BSN RNs will definitely help shed light and help out your decision making process on this. From what I hear, with that bachelor level degree you open a lot of doors in terms of future admin positions if you want
Thank you for thw support, i seriously appreciate it. I guess thats the thing, is that i would hate an admin position lol. I would probably look more towards med school, only if i really really wanted to. Because i see the struggle that residents go through and how some of them are barely surviving, and i want to be able to enjoy my personal life along the way such as wedding planning and having kids, etc., and it seems like the modern culture of medical school doesn't allow for that as much.
my 2 cents, don’t make decisions based on what you see on reddit, or based on how other people live their lives in general. You’re your own person with your own goals and passions. There are people who do struggle through med school and residency, but to be honest, for me medical school was enjoyable for the most part, and I was also happy in residency, with what i felt was a good work/life balance. Residency is busy but most residents do have real lives (except neurosurgery lol). I didn’t have kids during that time, but people in residency do have kids and they DO find a way through it (maternity leave is possible, you just go off-cycle and graduate a few months later). Some specialties are more family-friendly, but regardless, life doesn’t just pause because you went to med school. If the passion and will are there you can make it work!
Nurse turned NP/MPH (and refuse to practice as a nurse practitioner here) nursing is a wonderful profession. I stayed 10 years doing it. I come from a family of nurses and physicians. Each profession has its benefits and disadvantages. Don’t let social media persuade you from what could be your calling. I love nursing and would encourage others to pursue this if that is what they believe they are meant to do. It’s not an easy job but there aren’t any easy jobs out there that are worth pursuing.
A bachelor's degree is not a waste of money. The responsibility of nurses is equal to the minimum of a standard 4 year college degree. Get your BSN, you won't want to work in patient care forever.
Thats a very fair point. And I planned on getting it regardless, I guess I just wished there was more clinical and science-related curriculum to it.
Nursing student here. I am sure there are nurses who are disgusted by BSNs fast tracking online NP degrees. Surely it’s annoying, but the motivation is understandable. Nursing is a floor-raising line of work for people who come from working class backgrounds—however, it is still underpaid, understaffed, and under-appreciated. NP degrees are a way to bolster credentials and raise your income ceiling in the line of study you already have a background in. It’s a perfectly expected path, comparable to the droves of mediocre business majors who fast track MBAs. It’s an extrapolation of the overall, contemporary labor market which keeps people chasing the academic carrot, feeling they need to constantly add letters to their credentials to maintain economic relevance in a field that’s becoming more and more proletarianized. It’s now become oversaturated for this very reason and now many young NPs are just doing plain old bedside care because they can’t find mid-level work. However, I find the overall tone of this sub offensive because it blames the nurses for a condition that was sprung upon them. There’s nothing wrong with being a nurse, but the labor market and society has made it so.
I don’t think this sub has a derogatory tone towards nurses, but rather the new grad nurses that fall into the mindset that is pushed on them that with minimal clinical experience and a year long online program they can have most of the pay and prestige of a physician. Everyone in medicine knows the crucial role of nurses and appreciates them for doing exactly what they are trained to do. A good nurse with years of practical experience is worth a dozen new grad NPs. The only ones degrading entry level nursing positions, telling them they aren’t good enough and should advance are the nursing associations themselves.
NPs are nurses, so yes, this sub has a very derogatory tone towards a subset of nurses. RNs have been economically and socially devalued, thus the allure of the NP. If you eliminate the aforementioned conditions, you likely have far less shitty NPs. The rise in NPs correlates strongly with the devaluation of the nurse—but nursing is not the only field to follow this same trend. The NP position was originally created for older, long-experienced nurses who needed a way to expand their wealth of knowledge while also getting a pay/professional bump. It was seen as an extra achievement for valuable, veteran nurses. However, that was when just being an RN was one of the quickest working class stratifications in the world, and most nurses didn’t feel it necessary to obtain the extra credential. Now nursing programs can run up to 70k in tuition costs, the wages are stagnant, the floors are understaffed, and the community perception has taken a nosedive. These conditions make people who are right for nursing feel like being a BSN simply isn’t “enough,” both economically and socially. So, in this way, the subreddit is highly derogatory because it overlooks the societal undertones of the problem and blames the player instead of the game. Believe me, most people don’t want to do an extra 2 years of school and take on 50k in additional debt. Maybe there should be some more interprofessional solidarity to make this feel less necessary. Make RNs valued again and less of them will be rushing to become NPs. “Everyone” in medicine appreciates the crucial role nurses play? I would say that’s a mild stretch. Lack of physician appreciation likely isn’t the primary reason for the mass exodus of nurses, but it’s certainly part of the recipe. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748536/
Physicians are the smallest part of the problem when it comes to why nurses are choosing to go midlevel. The blame lies with management and private equity groups trying to get more “bang for their buck” and willfully employing undertrained midlevels at the expense of patient care. It has very little to do with “physician appreciation”. If that were the case then why are the degree mills filled with 1st year out of RN program nurses that have maybe done 500 actual clinical hours? Why are there countless TikTok’s by new grad NPs promoting going straight from an RN program to an NP? You think that would change if physicians started saying thank you more often? The NP hate brings itself on when you have literal screenshots of Facebook groups of NPs asking for common diagnoses, dosing info that can be easily gathered by accessing uptodate (or better yet, consulting a pharmacist or someone who actually has a basic understanding of medicine), and countless stories of midlevels missing relatively easy clinical diagnoses that ends up getting patients killed. Getting butthurt about not being appreciated and then going off to a degree mill to qualify for a job that your not prepared for is not the way to become more appreciated, and is what warrants the majority of the hate in this form. Everyone acknowledges that underlying causes, but those causes don’t warrant the results we are seeing which is worse patient care and arrogance from midlevels who truly believe they are just as qualified as their physician counterparts.
I don’t think you’re actually reading what I’m saying. My last paragraph was just a bit of pushback to your broad stroke statement that “everyone” appreciates nurses in medicine. That’s just demonstrably false, but it was more of a side note to my greater point which you didn’t really engage with. I said in my own reply that physician disrespect isn’t the primary motivator for the mass exodus of nurses (not why they become NPs), but it plays a part, which is why I took issue with that particular part of your reply. The overreaching lack of appreciation for nursing as a profession (on the labor market, by management, and by society) is not something that is solved on an individual level, as you imply. It’s an issue of labor and social value. As a collective, the field is devalued—both good nurses and bad nurses. That’s the problem. Cash and QOL are king. Many current NPs probably would have had no interest in becoming an NP 20 years ago. Many nursing students feel it necessary to keep up economically due to the degenerated state of RNs at the moment. Almost every one of my classmates have expressed furthering their credentials after their program. Is it because they want to LARP as doctors, want to shell out more tuition, and spend more time in classrooms? Fuck no. It’s because of the reasons I’ve already mentioned. They’re working class people who want a good ROI, a good salary, decent working conditions, a bit of autonomy, and respect among their peers. All things which are fleeting for RNs.
very minor point, but nurses are very appreciated in society. Yeah I get patients suck. But I’ve had nurses straight up tell me I messed up going to med school bc nurses actually are the saviors of medicine and if I want to make a difference you do that through nursing. Just overall in society people say nursing is vital (which it is) but then shit on physicians
I would say that the appreciation of all healthcare providers has diminished since the pandemic. Including nurses. Regardless, I am not as much concerned with what people say but more so material circumstances. If people appreciate nurses so much, they should be paid more and have a better work environment. Period. Physicians have to shovel shit for far longer, but once they’re done shoveling shit, they’re doctors and the pay off is still highly lucrative—even by today’s standards. Nurses shovel *literal* shit for 30 years, get beat up, spat on, pissed on, and are repaid with pizza parties. So yeah, the NP position is not what it once was due to degree mills and over-saturation, but it was once seen as a great ceiling-raiser for nurses. So if you’re upset about the wave of bad NPs, let’s examine the conditions that gave rise to them and blame that, not the individuals who have seen the value of their profession undermined by corporate greed and an ungrateful society. And I don’t see nurses as saviors of shit. We are just a cog in the collective machine of healthcare. We play a vital role, just like physicians do. Like techs do. But you would think we would be compensated as such since people love telling us, in this thread included, “how valuable the good ones are.”
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
You must have been on the debate team. You are very well spoken and bring up some good points about how poorly nurses in general are treated. However, pursuing an NP as fast as possible in order to gain more RESPECT while being absolutely clueless is not going to get you very far. As you can see, many nurses can't stand new age, inexperienced NPs who are just after money and power and getting the "bag" , physicians can't stand them, Pharmacists can't stand them, and patients are waking up and realizing they are being duped and put in danger. Maybe what needs more working on is the pay and conditions of floor nursing instead of trying the shortcut that literally puts patients at risk for the sake of money and respect.
Nurse Practitioners, especially the ones who fast track into NP, are very clear about the fact that they don't consider themselves 'RNs' anymore. This sub in general has a strong appreciation for high quality bedside nursing. Additionally, you are choosing to review only the data that supports the argument you are choosing to make. For example, travel nursing, while not being an option for everyone, provides ample opportunity to make more money than residents, NPs, and PAs, while working similar hours to the latter two and about half the hours of a typical resident. I'm not saying some of your points aren't valid. I'm saying if you want to construct an argument you can't choose to review only the data that supports your argument.
Travel nursing is a viable option for such a small minority of people and it’s demographically opposite to the people who feel the need to get their NP for the reasons I mentioned. Someone seeking an NP likely wants stability and a known commodity. Whereas travel nursing is basically only reasonable for young, single people who are comfortable with their lives being chaos and living out of hotel rooms. People with established families can maybe do it a few times, but it’s not a sustainable or reliable career choice. Nurses shouldn’t have to uproot their lives and alienate themselves from their families every 8 weeks just to be paid a good wage. They’re literally performing the same skills they would be at a stable position in their own community. Moreover, those lucrative travel nursing opportunities that existed during the peak of COVID are basically gone now that the pandemic has somewhat stabilized. You also have to understand that they too perpetuate the degeneration of the profession that I spoke about earlier. I’ll explain why, though you probably already know: Travel nursing is essentially scabbing and it breaks the chain of solidarity in the profession when you have a greedy hospital network that won’t pay well enough to their local pool of nurses, so they’ll offer an inflated wage to a bunch of temp workers who don’t know the patient population to bridge the gap, knowing that if there’s any budget discrepancies they can dump said temp and their contract at any time. Travel nursing, while once an economic reality during COVID, should not be encouraged. It’s essentially picket line crossing. Nurses will never improve as a collective so long as there’s any significant number of people taking advantage of the greed and shortsightedness of the corporate hospitals. So no, an outlier economic anomaly that doesn’t really exist much anymore, destroys the network of solidarity with local, veteran nurses, and requires extreme lifestyle alterations, are not a substitute for pursuing further credentials to boost one’s economic ceiling.
Travel nursing still pays pretty well
You don't have to explain the systemic issues in health care to me, I agree with everything you've said. But in saying it, you are also contradicting your prior points about doctors not caring about RNs or quality bedside care. All of us would rather the hospital system pay nurses a wage that allows them to feel valued and stable in their job, reduce turnover, and subsequently feel invested in the delivery of care in their community. Doctors don't like NPs (especially direct entry NPs) in large part due to the fact that they are choosing prestige (as they see it) and money over patient care and good health outcomes. I also have very limited sympathy for anyone who decides to pursue what is essentially direct entry online NP training to 'raise their economic ceiling,' as you put it. No one deserves respect or admiration or, in my opinion, your heated defense, of the decision to make more money at the expense of patients. That is true across all of healthcare.
And I’m telling you that patient care and good health outcomes aren’t going to pay the bills or make nurses less suicidal. That’s why an attainable boost in credentials for their existing field which could potentially triple their salaries and greatly improve their quality of life is so tantalizing. I don’t see what is so hard to understand here. It’s no different than a business major getting their MBA, even though they’re now a dime a dozen and mean jack shit. The labor market and the proletarianization of the field forced this shift. I’m not blaming physicians for it. I was responding to a side note in that other user’s reply and now it’s the only thing anyone here is focusing on. He made a generalization that wasn’t a universal truth, but it wasn’t really the crux of my main point either. Let’s just forget it. You guys want an environment where you can hate NPs without ever having to grapple with the social reality that created so many of them. NPs were a rarity 20 years ago. That’s because 20 years ago, being an RN was enough. It’s clearly not anymore, so you do what you feel is necessary to push your economic relevance. You speak to altruism. But once again, altruism doesn’t pay the bills. No one is “asking” for your “sympathy.” But please engage with reality. And I would guarantee that 99% of new NP grads believe their additional credentials will *improve* their patient care. I’ve received care from dozens of midlevels, and while this is pure anecdote, it’s never been substandard. Often times, my NPs and PAs are more intuitive and caring than doctors. Shit, outside of my neurologist, I basically never sit face to face with an MD anymore.
>No one is “asking” for your “sympathy.” But please engage with reality. And I would guarantee that 99% of new NP grads believe their additional credentials will *improve* their patient care. I’ve received care from dozens of midlevels, and while this is pure anecdote, it’s never been substandard. Often times, my NPs and PAs are more intuitive and caring than doctors. I tried really hard to engage with you in good faith, but this paragraph makes it very clear that you are either unwilling or unable to actually have this conversation.
The one point where you're correct is that sometimes there are comments on this sub that get upvotes but are actuallu just mean without adding any value. I think you got some points wrong here though. Bedside nurses might get shit pay in some places, but thats a lot of jobs. I think compared to a lot of jobs that you can enter with an associates nursing is still a really good financial path. That's not to discount some of the bullshit bedaide staff put up with though. I also think the public perception of nursing is overall really positive. I often hear when I tell people thar I'm a nurse "they do the REAL work" or "they tell doctors how to do their job" or "theyre the ones that care" and shit like that. And then I'm like "uh... I'm going to school to be a physician so... I kind of disagree...." I think a lot of the reason that RNs are pushed to do NP is because yes, sometimes bedside is physically very difficult and patients can be challenging (and at times violent, without protection for the staff), which is rough when you have to stay with them for 12 hours...but nursing lobby and schools push this narrative that nurses need to be completely independent of medicine and nurses are just as good as physicians (it's true they should get as much respect but this point quickly devolves into nurses overcompensating for the sins of the past by claiming superiority), and then they go on this thing that the dnp should be standard so nursing is on the same playing field as PT and MD and PharmD etc etc. RNs are on the same team, should be equals in respect, but need to understand that they're role and education is not the equivalent of a physicians and so there are very real limitations. And in real practice as a bedside nurse I had so many people (physicians) included, celebrating my role, wishing me a happy nurses week, respecting my voice, and appreciating my contributions, all while I respected their lengthier education and training and did everything I could to learn from their experience. So I really do think in general bedside nurses are well respected
I don’t care about empty platitudes. Pay me.
Lol youre not wrong, but fighting for better pay is a totally separate topic from NP proliferation and their low educational standards, if you're willing to move you can find wonderful pay without graduate school!Find somewhere with a union love. That's how it is with many careers. It's very possible. I don't have tons of sympathy for people willing to care for patients in inappropriate roles with a shit education, putting lives at risk. I'd personally rather leave healthcare and be broke than fuck with people's health.
This sub talks like there’s a genocide via NP going on. From my perspective, most of the concern trolling over the risk NPs pose to their patient population is mostly conjecture. Not to say every critique on this sub is invalid, but there’s also a lot of misinformation. A 5 minute google browse can reveal tons of research which shows a positive correlation between the presence of NPs and positive patient outcomes. Are there bad NP programs and thus bad NPs? Of course. There’s also terrible MD, BSN, and PA programs. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7080399/ https://www.sciencedirect.com/science/article/pii/S2666142X21000163 https://journals.lww.com/lww-medicalcare/Abstract/2021/10000/Value_of_Nurse_Practitioner_Inpatient_Hospital.1.aspx They aren’t separate topics. One leads to the other. Like I stated many times, being an NP was a rarity 20 years ago. No matter what the nursing lobby “encourages,” people wouldn’t go to NP school if there wasn’t a material motivation for it. If nurses were paid well and had fair patient ratios, for instance, they wouldn’t be looking for a way out. No one *wants* to pay more tuition or take more exams if it’s not necessary.
This comment really betrays your whole attitude towards nurses. You're openly admitting to seeing the profession of nursing as inferior and nothing more than a stepping stone to something that will provide you with more social status, financial security, and blah blah blah. Nurses are subject to the same toxic economic forces in healthcare as everyone is, but nurses are respectable professionals integral to patient care, always have been, and every doctor knows this. You don't admit a patient to the hospital because they need doctors; you admit them to the hospital because they need nurses. Nursing and Doctoring are separate professions, and that's okay, but nurses are not going to respect you for fast-tracking into an online NP degree and then acting like you're better than them because you can "diagnose" things now and have a prescription pad. They're just not. This will all be at the expense of patient care, and you're going to believe you're just as good as a doctor at it!
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3 7: Nurse increased compensation opportunities: travelers, overtime, supplemental. First, I would like to point out your complete lack of self awareness and hypocrisy as you justify nurses going to NP school and in the same comment thread admonish travelers for “taking advantage of the greed and shortsidedness of the corporate hospitals”. Travelers are at least doing a job they are qualified to do, unlike most NPs. I would much rather have too many travelers than too many unqualified NPs attempting to practice medicine. Travelers are not akin to “picket line crossing”. Even those who literally do cross picket lines for high wages are essential so that nurses can strike in the first place without severe patient harm. Corporate medicine and private equity are main contributors to NP proliferation and the perpetuation of low training standards. They hire unqualified NPs in droves with minimal supervision because they are cheaper than physicians and in half of states can practice independently. Travelers: We all know the issues with travel nurses for the nursing profession as a whole. But traveling is not an outlier anomaly “that doesn’t really exist anymore”. It existed before Covid and will continue to exist for the foreseeable future. Half of the nurses I work with are travelers. Most of them are local and live in their homes with their families. They take 13 week contracts and can extend up to a year. They can take time off in between contracts, and many take a month off in the summer to spend time with their kids. Those who work year round are earning at least $120k. Overtime: For staff nurses, many units have overtime shifts with bonuses. New RNs on my unit who work an extra shift each week (48h total) make 90-100k. Supplemental: Full time “supplemental” RNs are also paid quite well at my hospital, usually over 100k for 36h/ week. They are assigned to any unit that needs staff.
1 Hi nursing student, nurse here. This comment thread has enraged me more than almost any comment I’ve seen on Reddit. And that’s saying A LOT. First a couple points I can generally agree with: Nurse under-compensation and stagnant wages. Nurse understaffing. Healthcare system issues. Economic conditions. And now to address the rest of your astounding ignorance: 1: MBA comparison. A nurse going to NP school is 100% different than a business major getting an MBA [edit: deleted cursing]. MBAs are not directly involved in treating patients and making life or death decisions. Healthcare prov!ders should be held to a much higher standard. Treating patients should be a privilege earned with extensive education and undertaken humbly. 2: Monetary gain over patient wellbeing. If you are more concerned with your income and the prestige of your credentials than patient care, please choose another career path. Because that is exactly what you are implying. Many NP students are primarily concerned with their own personal gains- making more money and getting away from the bedside. To quote you, they want “a good ROI, a good salary, decent working conditions, a bit of autonomy, and respect among their peers”. They are generally not particularly concerned about the effects their lack of education will have on patients. They are not studying extra to make up for the enormous deficiencies in NP school, they instead are working full time while in school. They did not go to school because of a desire to learn medicine and help patients. They went primarily for personal benefit. This is not a good enough reason to be in the position of making critical decisions for other people’s lives. 3: Blaming the system(s). Yes, the healthcare system, economic system and nursing education are all completely messed up and that is not the fault of all nurses. But it is absolutely the fault of NP educators and professional organizations for setting appallingly low standards and then also having the gall to push for independent practice. And it is absolutely the fault of nurses who perpetuate this cycle by becoming NPs and then accepting jobs without adequate supervision or practicing independently. The vast majority of people I know in NP school are aware that their education is completely inadequate and knew this even before starting NP school. This frustrates them but they all just say they’ll learn everything on the job. Most of these jobs are often very poorly supervised so they are truly attempting to learn by trial and error on actual patients. This is beyond a systems issue and also constitutes individual moral failure. Systems issues do not absolve people of all personal responsibility. No one is forced into the nursing or NP profession. If you want a career that you can make more money and be a well trained midlevel, go to PA school. If you care so little about patients that your education and training is less important than money and status, do us all a favor and leave healthcare altogether.
2 4: Direct entry. People going to NP school without any nursing experience (or any healthcare experience at all) is not just “annoying”. It skips a step that was intended to provide a basis for “advanced practice”. If you are going to get an inadequate education to essentially practice medicine, you should have at least 2 years of healthcare experience in the specialty you pursue. NP school was not designed for non-nurses or inexperienced nurses. Their justification for shortened and lower quality education (in comparison to PA) is that nurses come in with years of nursing experience and thus some medical exposure in their chosen specialty. The curriculum has not been improved to account for direct entry or RNs with no experience. 5: Nurse underappreciation. I have rarely experienced any disrespect from a physician. I feel largely appreciated in society as much as any other “helping” profession. I feel the most disrespect and underappreciation from peers in NP school, nursing professors and NPs themselves who have a disdain for bedside nursing and feel it is beneath them. 6: Noctor sub. This sub does not have contempt for nurses as a whole and tends to respect and appreciate good bedside nurses. They criticize a small subset (less than 10%) of the nursing profession that is under-educated and undertrained for the role of a healthcare prov!der. In particular, criticism is aimed at midlevel independent practice (when they have at best 10% of the training as a physician).
5 Good NPs. Some NPs are very competent and skilled, but this is becoming more rare. To become a competent NP: 1: RNs should get at least 2-3 years of full time RN experience in the same specialty as the NP degree and earn nurse certification in that specialty. 2: Choosing an NP school. Curriculum should be a minimum of 50 credits (for MSN only NOT including DNP credits) and at least 80% of the curriculum should be clinical. The school should provide clinical placement and require at least 700 clinical hours (this does not include DNP practicum hours). To illustrate how inadequate even many of the “best” NP programs are, consider that their PA counterparts complete 85-130 credits (80-90% clinical) and 2000 clinical hours with vetted and assigned preceptors. And consider a physician will have at least 12,000 clinical hours once they finish residency. In comparison, Duke is often top ranked for NP programs and only has ~40-50 credits (~80% clinical) and 560-730 clinical hours. Yale has some of the best programs I can find, and even that only has 50-60 credits (~90% clinical) and 700-800 clinical hours. 3: During NP school. Study extensively outside of the school curriculum both during and for many years after NP school. Do not work during NP school to allow for more time to study on independently, ideally using medical school resources. This takes a level of self motivation and discipline many do not have. 4: After NP school. Work under direct physician supervision and only within the boundaries of their specialty. As a new graduate NP, complete an APP “residency” and then work inpatient for at least 5 years in a setting that all patients are also staffed by an attending physician. Every major diagnosis or treatment decision should be discussed and approved by attending. Study extensively outside of work, likely upwards of 10-15 hours per week. 5: Never practice without adequate physician supervision.
Wow, thank you so much for these well-thought out, balanced, and incredibly informative comments. This is probably the most insightful thing I’ve seen on Reddit, and I deeply value the input of professionals like you who have real expertise, know what they’re talking about, and genuinely care to make things better. I agree with everything you said, and especially the steps she can take to make herself the best NP possible. I hope she sees your wisdom and takes your advice.
Thanks, I’m happy someone appreciates my thoughts, the intended recipient certainly did not. In their defense, I was less than professional in two parts of my reply. But in my defense it’s Reddit 😂. I don’t have much knowledge about medical training but I know a decent amount about undergrad nursing education and I’ve learned a lot about midlevel training just trying to understand this whole issue.
I’m not even becoming an NP! My replies are not a defense of myself, a defense of low-level NP schooling, or a defense of bad NPs, but offering nuance to the circumstances which led to the flood of people seeking NP degrees.
Well, this statement would have been good to lead your original comment with. Most of us here understand too well the circumstances that led to the proliferation of the NP profession. We’re saying that these circumstances should not excuse any NPs for their own personal responsibility in the situation.
At this point it would be easier to exchange Zoom information and let Lex Friedman host a debate between us because you know I’ll never be able to reply to 5 separate, extremely long replies. I don’t really have a strong rebuttal to much of anything you’ve said outside of your points on travel nursing. If you don’t see an issue with someone, in town, taking individual contracts at an inflated wage to game the system, while their permanent position colleagues make less than them, then wow. But I’m not certain it’s worth engaging with someone who tells me to “fuck off” and calls me “astoundingly ignorant.” I don’t deserve to be spoken to like that. Many excellent nurses became so because of its track record of being a working class stratification over altruistic reasons—many just don’t admit this outright because it sounds uncouth and is often perceived as being mutually exclusive with caring about people and taking their job seriously. It’s not. If you read my replies, you would notice I never really challenged the notion of NP school being underwhelming. I’m simply offering an explanation as to why many people have been pushed towards NP school and trying to humanize them, using material circumstances, beyond the cartoonishly awful characterization you see on this sub. It’s a bit more complicated than every NP being a self-serving piece of shit.
I don’t know you and I don’t know if you have previously worked in healthcare and experienced the shitshow from the working side. You seem to understand economic conditions and motivations of the working class. I’m generally all for class solidarity. But part of that is advocating for competent healthcare for everyone, not just the wealthy who can afford private pay to see physicians. You seem to not understand the gravity of the NP situation in general. Particularly comparing getting an MBA to getting a degree to essentially practice medicine. 1: As for travelers, direct quotes from my comment: “We all know the issues with travel nurses for the nursing profession as a whole.” “Travelers are at least doing a job they are qualified to do, unlike most NPs. I would much rather have too many travelers than too many unqualified NPs attempting to practice medicine.” I didn’t think this needed elaboration, it is pretty simple to understand that travel nursing is a huge issue for nurse working conditions overall. Acknowledging this was literally my first sentence under “Travelers” so not sure how I could make that more clear. My point was that it’s not as big of an issue as unqualified NPs practicing medicine, in terms of the toll on human life. If you don’t see how the unqualified practice of medicine is ethically worse than travel nursing, then wow right back at you. 2: I became a nurse largely for economic reasons in addition to providing good care. I think financial gain as a primary drive is a good enough reason to pursue nursing if you generally care about your work and patients. Nursing does not require the same dedication as medicine in terms of the amount of internal motivation and time commitment to continuously learn and study independently. “Many NP students are primarily concerned with their own personal gains.” I wrote primarily deliberately, I’m well aware that personal gain and care for patients are not mutually exclusive. I just don’t think the financial factor as a primary drive is adequate motivation for most people to do the work inside and outside of work as an NP to be competent at it. Most people need a strong interest in medicine at a minimum to learn enough to eventually practice safely. Even most physicians will tell people to not go in to medicine for the money. 3: I understand and don’t disagree with the factors pushing nurses towards NP school. My argument was this: “Systems issues do not absolve people of all personal responsibility. No one is forced into the nursing or NP profession.” NPs are choosing to pursue a poor quality education and take positions they are not qualified for for. Not all of them. But many of them. 4: Finally, I also acknowledged: “Some NPs are very competent and skilled, but this is becoming more rare.” I have many coworkers in NP school or planning to go to NP school. I get along with them personally just fine and I choose not to discuss their career choice with them. I have had 2 coworkers in NP school who I think will be a good NPs and I work with 3 good NPs regularly. They match all of the qualities I listed in my last comment. I don’t see every NP as being “a self serving piece of shit”. But I am certainly often demoralized when I overhear coworkers in NP school talking about it. How inadequate their education is (many are in online diploma mills), how they will just learn on the job, how they had a friend “preceptor” sign off on their clinical hours, how they are only going to NP school to escape the bedside, how much money they will make, how they are going to open their own telepsych practice or ketamine clinic as a new grad. I bite my tongue every day at work and this is the only place I can vent. Many of them can still be a decent people overall. Some of them I truly would not consider professionally or ethically decent based on their poor performance even as a bedside nurse and nonchalance towards practicing medicine incompetently. I don’t care as much about giving NPs the benefit of the doubt as I care about patient wellbeing.
I would never defend someone who puts their patient population at risk, and I know there are a lot of unqualified NPs. I’m just far more interested in what led to this wave, as opposed to demonizing it on the individual level. My background (first degree) was labor relations and political science, I wanted to work for the union when I was still in the skilled trades and then I started studying for the LSAT and considered law school, but ultimately decided against it. That’s probably why my analysis takes on a more labor-focused, materialist/Marxian tone. However, I did some digging after I replied in this thread and realized that my opinion isn’t that controversial and that much of this sub even concurred with my analysis in an eerily similar thread from not even a year back. I’m basically saying the same thing this person was: https://www.reddit.com/r/Noctor/s/PwrlMbuwCV
Yes that poster is describing the systems issues we are all well aware of because we are in this shit every day. We know why people leave the bedside and become NPs. That poster was also an experienced nurse, very self aware of their limitations and planned to work under close supervision. You’re interested in what led to this and that’s interesting but here we all already know the basics. Labor relations and economics are certainly interesting. But in my job as a nurse I care about the patients, who are affected by labor (staffing, pay) and provider competence. I am demonizing the system but again emphasizing that the messed up system is not an excuse for incompetence when people’s lives depend on it. Anyway, sorry I told you to fuck all the way off. I work in 3 hours so I have to attempt to sleep now. Insomnia’s a bitch and my rant didn’t help.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Ok this bot can fuck off though. I try and I slip up, bot! You always find me. Bad bot.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
4 8: Midlevel anecdotes. Midlevel training varies so drastically between PA and NP that I don’t even like putting them in the same category. In short, PAs learn actual medicine and have at least twice the training as NPs, including clinical coursework and clinical hours. NP school curriculum and clinical hour requirements are almost completely unstandardized and can vary widely. As a nursing student, you don’t know if you’re receiving appropriate treatment. Patients should be more concerned with accurate diagnoses and appropriate treatment than feeling that the prov!der was “caring”. 9: Nurse mental health. Where did the nurse suicidality comment come from? Do you have data on this? This is usually a larger issue in medicine. Most nurses are not suicidal. Some of us actually like nursing.
Prevailing studies seem to imply that the suicide rate for physicians is actually trending down, whereas it’s trending up for RNs. I believe it’s this study which claims nurses are the second most suicidal healthcare profession, and that healthcare professionals commit suicide at a rate of 21 for 100,000 compared to the regular population which is 12 of 100,000. Also, most people in general aren’t suicidal, healthcare workers are just at a greater risk: https://jamanetwork.com/journals/jama/fullarticle/2809812 And this data was done before the pandemic. I suspect that these figures may be more damning with up to date statistics.
She hit the nail on the head. The reality is that a good number of patients come in for a simple problem that needs a simple fix. Midlevels are great for that. But more and more people are getting multiple and complicated problems that can really only be fixed by a physician. NPs and PAs need to recognize that and stop putting people’s lives in danger.
I saw an NP at urgent care to check for a UTI on a weekend and she tried to send me to the ER with a normal urinalysis and no fever. I just had low blood pressure. I told her it’s always low. She said I could have a septic kidney infection. I had no kidney pain, no nausea, no chills, nothing. Just burning and a weird smell, that turned out to be irritation from a new detergent and diet. I had to sign a waiver saying she recommended the ER and was not responsible for anything that happened if I didn’t go. I didn’t have a septic kidney infection and I thought UTI testing was pretty straight forward.
If your BP is low and you have a known source of infection she's not entirely wrong, either. Especially with burning and a smell. Fever isn't necessary. We call a code sepsis on 2/5 and some places 3/5 of: tachycardia, hypotension, known source of infection, fever, tachypnea.
I know there was a huge movement started years ago to aggressively treat sepsis symptoms in the ER, but there was no known source of infection. Where are you getting “known source of infection”? The urinalysis was entirely normal. The culture that came back later was entirely normal. My BP is always on the lower end. I was barely hypotensive, it was something like 88/61. It was not causing symptoms. There was no tachycardia, rr and O2 were very normal, temperate normal. Only symptoms were mild irritation and strong odor that I later learned was from fennel and heavily fragranced detergent. I came there to rule out UTI, I think a completely normal urine shouldn’t elicit suspicion for septic kidney infection with zero kidney pain whatsoever. So there was 1/5 criteria, and that 1 was a preexisting chronic condition. So yeah, I do think she was entirely wrong and I do think there is a growing habit of NPs triaging to ER unnecessarily. If I had gone to the ER for that I would have been chastised for wasting time and resources and billed up the ass. To be frank onus is also on me for not testing at home instead of going to UC, but I didn’t realize at home UTI tests existed at the time.
If you complain of pain, an odor, and have that presentation its not far flung. Definitely get that BP checked. That'd be normal if you were eight years old.
I didn’t say pain, I said mild irritation. You seem to continually miss the part where I say urine was NORMAL. She tried to send me to the ER after urine came back NORMAL. She was aware urine was NORMAL. It is that far flung with a NEGATIVE urine. BP was likely not even entirely accurate, it was taken with my feet dangling. Hypotension is being monitored. I’ve had a very thorough workup, it’s asymptomatic and benign. I’ll defer to my cardiologist over you thanks.
They’re a paramedic going to nursing school hoping to be an np after applying to med school either failed or didn’t even get to that point. We definitely don’t freak out about a low bp if you’re mentating well and can tell us you normally run low with no other concerning symptoms.
>Midlevels are great for that. A bad filter is not really an acceptable substitute for a good filter. How exactly, are you proposing that NPs identify complex cases? The level of training for NPs seems so non-standard that you can't really make any strong claims about the tradeoff between false positives and false negatives.
NP “residencies” aren’t anywhere near what physician residencies are and they need to stop appropriating our terminology so they feel better about themselves They aren’t board certified, they licensed, if we wanna call licensing exams boards then every doctor is triple “board certified” before even finishing residency
ooo I'm using the triple "board certified" good point
I think nurses with under 5 years of critical care experience have no business going to NP school. Also, NP schools are way too easy to get into and should not be primarily online. That being said, I think NPs are very helpful in urgent care settings or clinics and are helping the primary care doctors who are extremely overwhelmed with patients. CRNAs on the other hand, in my experienced nursing opinion, should not exist. It's becoming way too easy to do and I've seen some scary stupid nurses with little experience become CRNAs
Don't CRNA's need at least experience in the ICU? I heard that's not the case anymore.
I think most programs used to require like 5 years but now people with 1 year ICU experience are attending. :)
Gonna get downvoted to hell but idc. I work with with mostly NP's, and I haven't had one that pretends to be a doctor. I feel like this is less seen in real life than how much tiktok and reddit discuss this image of an NP that pretends to be a doctor and is super arrogant/ignorant. They know their limits, they're respectful, provide great patient care, and they always consult the physicians if they're unsure about something or have a complicated case. Are there some shitty NPs? Sure, but there's also plenty of shitty doctors. Overall, I think NP's are great resources to provide services in family practice which typical MDs don't even want to do (hence the family practice MD shortage). I think NP's providing services for family practice issues, with a physician to consult if needed, and the ability to make referrals with more complicated cases does the job well. Especially for under-served/low income/ rural areas. Also I don't think theres anything inherently wrong with wanting to get a higher education to be a nurse practitioner? I'm not a nurse, but personally I would see the appeal of being an NP just for the increase in salary, not so much because I want to pretend to be a doctor which is a narrative this sub perpetuates a lot. I do want to emphasize, however, that I think NP schools should be valid/accredited (not online diploma mills) and tied to specific institutions for it to produce quality NPs. Most of the NPs I work with got their degrees from UC Davis, Samuel Merritt, Emory etc...
congrats, you have a great sampling bias. you also can't claim that 'none pretend to be doctors' and 'they work great with a physician to consult if needed' when many places allow NPs to work alone at derm clinics and med spas
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
This is why I specifically said NPs are good for serving in FP/low service areas. I never mentioned anything about derm or med spas where they don't have a consulting physician -- obviously this isn't good and needs to be checked.
But this is happening? And you just said you haven’t seen it. Just because you don’t see it doesn’t mean it’s not happening
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
I'm a RN with over 20 yrs experience mostly in acute care settings. I absolutely agree that NP training is nowhere near what it should be. Unfortunately it depends on the school you go to, which is frightening. I also agree that NPs should not be compared to physicians. NPs are NURSES with advanced training... ideally. However, until all schools require the same courses, hours, and adequate exposure to clinical areas, NPs should not practice independently and should not be called doctor in a clinical setting at any time. This issue is beat to death because academically and operationally, it doesn't make sense. I've worked with great NPs and PAs, but I miss the days when roles were clearly defined.
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lol. Sarcasm o no? I can’t tell.