Nurse Practitioners - Partnering with Patients

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UPDATE: I wrote the article about the education and skills of nurse practitioners (below this update) in 2004.  For the past 3 years we have given nurse practitioners a good try as Primary Care Providers.  And although they can be very qualified, and provide excellent medical care, we have found some things lacking in the field.
  1. First, we have found that there lacks stability in providers.  NPs seem to change jobs often and some at least, do abandon their patients.  One very ethical nurse practitioner who was the head of a clinic, a part of chain of Clinics which closed suddenly, established at his expense and time, a website where the 12 nurse practitioners employed by the clinics in the chain, could provide follow up information for their patients.  NO NPs took advantage of the website even though he offered it for free (and including updates by his web geek, if NP's furnished the information).  He was the only NP employed by the chain, who did NOT abandon his patients!

    2. We were among the patients abandoned by a NP who worked at one of the clinics in the now defunct chain.  Our provider did not answer emails or phone when it would have been no problem for him to refill our prescriptions while we were searching for another provider.  This abandonment, caused a lot of stress for us.

  2. Then we found that NPs can allow their emotions to effect their handling of patients, thus coming across as unprofessional to say the least - this can also be hurtful to the patient.  This seems more true of NPs than MDs most of whom seem to follow at least a minimum level of professionalism (for the most part) which limits their being discourteous to patients OR prospective patients.


    3. Our experience here was that after the NP from the now defunct clinic chain, abandoned us, another NP agreed to see us and to re-fill my prescriptions first (because she was not available for a month to see us) after being specifically told what they were,  but then, when she realized that a couple of them were class 3 (which I take small amounts of for arthritis pain - not uncommon for a 63 year old), she balked and got rude, suggesting I was a drug addict and needed monthly follow up which she would be unavailable to provide. It was a moot point anyway because the clinic she was with, closed before our appointment would have been.  Another NP whom I had interviewed a couple of years ago and asked if she could treat me, detailing my meds, agreed it would be fine if I came to see her. At the time, she wanted me to advocate to the clinic director for a place for her.  But now when I approached her to treat me with no change in what we had discussed, she informed me that she could not treat me because the doctor she works with, has restrictions on what she prescribes - this is the same doctor she worked with when I interviewed her 2 years ago.  Seems she might have been misrepresenting things at her interview.

  3. Finally, we are shocked to hear that the Board of Nursing totally governs nurse practitioners and can, without evidence censure them. For a nurse practitioner who is unfairly ruled against, there really is no recourse with the court system because the Board of Nursing has the final say. This, we feel, is holding the profession back because it is likely that excellent practitioners who are censured unfairly or inappropriately, could be disheartened and leave the field.


    4. We have witnessed one of the best, most respected, most qualified, most ethical nurse practitioners get censured by the BON for one of his diagnostic decisions despite having collaborative evidence and testimony from two physician specialists, confirming his decisions were correct and appropriate for the case in question. One of the physicians was even on the phone long distance to give his testimony at the hearing. None of this mattered, it seemed, to the BON which apparently had made its decision long before the hearing, the hearing only being window dressing, and the evidence presented was basically ignored..

    Because of the foregoing, although we feel that nurse practitioners have excellent education and can be as qualified as GPs, we also feel that the restrictions placed upon them by the board of nursing and other factors may hinder them in a PCP situation as far as providing adequate medical care.  Thus, we have decided to return to physicians for our medical needs.

     

The following article details the nurse practitioner paradigm which in its ideal form (without a less than educated, biased Board of Nursing to lay down inappropriate decisions against NPs) could and does in some cases, really add to good medical treatment.

If you are like most Americans, you may have heard the term ‘Nurse Practitioner’ but know very little about this dynamic role. Some myths that have been suggested in the past by the popular press include:

  • They are junior doctors with less education
  • They don’t know much about the medications they prescribe
  • They are just nurses

Some professional medical associations heartily with the above (in fact, they often feed the media with "facts" like the above!)

So it can be confusing.  Let's examine each of these points.

1.  They are junior doctors with less education  WRONG.

Like many other people, I never questioned this one.  After all, don't doctors go to school for 12 years?  Well, partially true but let's take a closer look.  The B.S. pre med program doesn't have much in the way of medical studies except for Anatomy and Physiology, a course which the B.S.N. program requires as well.  It also, should be noted that physicians who are not going into a specialty, in other words, general practitioners, in addition to a general science B.S, may have 4 years of med school (2 of which are mostly practicum, not book learning) and 1 year of internship. It should be noted that their year of internship and any residency requirements they fulfill are NOT a requirement for graduation from medical school, but actually needed for licensing and employment purposes.

For example: School of Medicine - Admissions

Indeed this is all that is required to go into practice.  To contrast, the NP has a BSN, a large part of which emphasizes medical training, patient care, pharmacology and practicum.

For example: AS(n) BSN Requirements

Then, for the MSN, another 2-3 years of medical training, patient care and pharmacology with 780 hours of patient contact (like an internship) to graduate with an FNP (Family Nurse Practitioner)!

For example: Family Nurse Practitioner    Core

Bottom line, NPs have similar education compared to most GPs! (General Practitioners)  

It should be noted that BSN's, MSN's and NP's study many of the same textbooks which GPs study!  Additionally, they keep up their education with the same ’Continuing Education’ credits which physicians use and they read many of the same peer reviewed medical journals!

2. They don’t know much about the medications they prescribe. WRONG.

In our experience, NPs keep up on medications, attending the same seminars (usually held by pharmaceutical companies) that GP physicians attend.  Since their pharmacology studies are similar to that of physicians, NPs can prescribe as well as physicians and in some cases, where they endeavor to know the patient, perhaps better...  

It's becoming more and more clear that knowing the patient as a whole person and LISTENING to the patient might well make for LESS prescription errors in medicine.  Because each body is different!  (In fact, many physicians are beginning to pick up the paradigm of knowing their patients well - making themselves available in email etc).

3. NPs are just nurses:

First of all, NPs started as nurses but have gone far beyond nursing, however, nurses are often the primary healers in the medical chain and considered by many, to be the most trusted professionals working today.  And secondly, NPs have utilized their nursing skills to become excellent medical providers. Finally many NPs have picked up specialties like cardiology, neurology and more and share this expertise with their patients, something which is not necessarily true of many GPs!

So why should you switch?

At this time, we do not recommend switching to a Nurse Practitioner as a primary care provider, although those working in ERs and other protected positions can definitely be trusted to provide excellent medical care.  We sincerely hope that in the future, that the restrictions put upon nurse practitioners by the Board of Nursing, are removed so that they can be allowed to practice excellent medicine as a PCP.  The paradigm is definitely without question, a good one.

More info: