Talk:Nurse practitioner

Should

Should there be a link to CNP in the entry and at the "see also"? All they do is loop back to this page

Its because (at least in the US) they refer to the same thing. Gtadoc 00:23, 17 July 2007 (UTC)

Americacentric

This is quite possibly the most americacentric article I've seen in a long, long while - we do have Nurse Practitioners in other parts of the world y'know! Will try to work in some stuff about NPs in the UK, does anybody else have any experience of them abroad? --John24601 20:48, 27 August 2006 (UTC)

How interesting! This citation was placed in 2006.. and STILL there is not much in the article on NP's around the world... hmmm... maybe that's because the rest of the World has little support for Advanced Practice Nursing... Face it Chaps.... this is one area that only the U.S. excels in.. However, I can't very well add this statement to the article now..Can I ? 97.82.248.155 (talk) 13:55, 13 May 2009 (UTC) -Leonard J Matusik RN/MSN; BSPharm RPh2FNP@yahoo

Not without a reliable source to back up your personal POV. WhatamIdoing (talk) 00:58, 14 May 2009 (UTC)

"44 States"

Some sources say all nurse practitioners can prescribe medication in all 50 states. Is there a link to this anywhere?

Also some sources indicate that nurse practitioners need at least minimal physician supervision in all states Gtadoc 02:19, 18 June 2007 (UTC)

This article also needs to be changed to indicate what the scope of practice is for a NP, it makes it seem as they are same as a physician which is a dangerous and misleading inaccuracy.

No physician supervision is required whatsoever in Washington State where nurse practitioners have complete autonomous practice with regards to legend drugs, controlled substance prescriptions, and even can recommend medical marijuana to their patients. So, I'm not sure the specifics of the other states, but the State of Washington does indeed allow for complete and autonomous NP practice, and there is nothing misleading or dangerous about it. 64.184.170.110 (talk) 08:26, 30 January 2011 (UTC)

Yes, NPs can prescribe in all 50 states. Some states require the name of the collaborating physician (if applicable) on the Rx pad. Most states restrict the prescribing of narcotics to some degree.

source: "US Nurse Practitioner Prescribing Law: A State-by-State Summary" http://www.medscape.com/viewarticle/440315

71.242.234.90 (talk) 21:28, 20 February 2009 (UTC)Denise

Worldwide view

Someone tagged this article as saying it does not reflect a worldwide view. As far as I know "Nurse Practitioner" is a term only used in the US // it only reflects a US occupation. Thus I'm removing it for now 167.193.84.7 19:18, 26 February 2007 (UTC)

That tag appears to have been added by User:Lima Golf on 10th Jan 2007 - but I wuld agree with it. Nurse practitioner is a term used in the UK & I feel the article only reflects the view in the USA - particularly the sections relating to post-nominal letters & Education, licensure, and board certification. — Rod ^talk 19:49, 26 February 2007 (UTC)

This article most certainly reflects only the application of "nurse practitioner" in the United States. It does not reflect the rest of the English-speaking world and should state such.

So why not add nominal letters and education for nurse practitioners in the rest of the English-speaking world?

This is, I know, original research, which is why I have not edited the article page, but my wife is currently undertaking an Advanced NeoNatal Nurse Practitioner course in the UK (University of Southampton, as a reference) and I am surprised to see that the article concentrates only on the American field, whilst in the UK ANPs have been recognised for over 10 years. -- Simon Cursitor (talk)

I believe I should also point out that Nurse Practitioners have existed in Canada just about as long as they have in the US!! They are an essential element in our healthcare system...why they've been left out of this article is beyond me!

--Dan —Preceding undated comment was added at 21:26, 25 October 2008 (UTC).

I work in the US and my experience is mostly in the US and India, I don't know very much about NPs elsewhere, perhaps some of our Canadian and UK residents could contribute to the article? —Preceding unsigned comment added by 67.132.98.44 (talk) 20:19, 27 December 2008 (UTC)

plagiarism?

a lot of the text on the wikipedia page for "nurse practitioner" is identical to the text on this page:

http://www.womenshealthchannel.com/nursepractitioner.shtml

If this (above) link is the original, shouldn't it -- at the very least -- be cited?

More important, the page is essentially an advertisement for nurse practioners, i.e. it's far from an objective discussion of what an NP is. I have nothing against NPs, but there should be a difference between an encyclopedia and an endorsement.

I agree, it also is missing some important information regarding scope of practice. It seems to want to make comparisions with physicians and does not communicate that NPs are mid levels and have a clearly defined scope of practice that is not the same or similar to a physicians.Gtadoc 02:52, 18 June 2007 (UTC)

Please post in the talk page if you wish to make changes to the page that alter the NP scope of practice. Several editors have tried to alter the page to make NPs appear to be basically physicians in all but name, this is not at all accurate. Gtadoc 20:07, 16 July 2007 (UTC)

good page

I liked the page on NPs and found most of the info accurate and concise. I refer prospective students to this page when they ask about what an NP is. In reading some of the comments, I disagree with "gtadoc", nurse practitioners are independent healthcare providers, and many have a scope of practice which is easily equal to that of a given physician. Physicians did not invent healthcare, nurses have been doing it just as long. In fact, we must ask ourselves if nursing, primarily a women's profession, would have progressed a bit faster if there had not been a large gender gap in our culture. Nurse practitioner's practice is expanding all the time, and often there are some physicians who feel threatened. Luckily, there are enough patients for all of us. At any rate, thanks for the page! —Preceding unsigned comment added by Achnp (talk • contribs) 01:36, August 29, 2007 (UTC)

I disagree with the statement that the scope is more or less equal; perhaps to what a first year resident would do but beyond that they are very different. It is different to say that they see similar types of patients and to say that they are capable of doing the same diagnosis/procedures. The first is true for the most part if speaking of a general practitioner (which is a dying breed) and to a lesser extent a family practitioner. It is not at all true for all other types of MDs. The second is defenately not true and will get an NP in trouble if he/she goes beyond their scope of practice and attempts to work as an MD while only being trained as an NP (or PA for that matter). Allgoodnamesalreadytaken 03:06, 13 September 2007 (UTC)

This page had some good infomation but I was really looking for the benefits of being a pediatric nurse and since this was the most closely related topic I settled for it. I was just hoping that someone might have some infomation about the benefits, I would really appreciate.

My email address is e.m.2009@hotmail.com

Thank you for your time. Sincerely, Emily. —Preceding unsigned comment added by 216.11.243.60 (talk) 13:40, 14 December 2007 (UTC)

The gap between physician proficiencies and NP proficiencies is huge. Another physician and myself recently hired NPs. We are open minded, and fully expected them to behave professionally: like the physicians we had worked with. We were wrong. All 3 of the NPs that we hired are extremely well and extensively trained. Two have over 10 years of experience in our field of Psychiatry. These were the differences that I see:

1. They are clinically immature. Their critical thinking was at about the level of a First or Second year psychiatric resident, overall. They misdiagnose patients. 2. They are unprofessional. They openly tease, compete with, or criticize the physician who hired each of them in front of patients. They 'show off' in the charts, rather than being protective of the practice. Even though they are independent practitioners, they "call in sick" as if they are employees, and expect someone else to just take up the load for them. 3. They are arrogant, and expect the office to adjust to their "superior way of doing things" rather than trying to fit into the office as it is and has been. 4. They gossip, talk a lot, and don't seem to have to do things like read, study, or think carefully about their cases. 5. They think they know as much as physicians even though they have at best 1/4 of the training of a physician; they think they care more about the patients than physicians do, and they think they are more thorough because it takes them longer to do simple things. 6. They cherry pick the 'good' patients. 7. They abuse the office staff by having them do work for their convenience, like have them "bunch up" patients.

These characteristics occur in 3 out of 3 of our nurse practitioners, ages 30 to 60. This same arrogant attitude is reflected in this article, where it is never acknowledged that NPs are supervised by physicians or that their education is far less. I have never been nervous that NP's are equal to physicians, but having worked with the 'best', now I am nervous about how much they overrate their skills and how low is their level of professional maturity. I sincerely wish I could be more positive, but I cannot.

Debra MD (talk) 23:26, 3 September 2010 (UTC)

I just have to say to that: Anecdotal Evidence ring a bell? Sapphiremind (talk)

As a non-medical editor, this page smacks of NP advocacy -- to wit, cit. 4 to a blog advocating independence for Maryland NPs, etc. But the comments above, while they may be experientially true, are either advocacy (Achnp), are anecdotal and seem to reflect professional jealousy (Debra MD) and do nothing to improve the entry or make it more objective. — Preceding unsigned comment added by Webistrator (talk • contribs) 17:34, 29 July 2012 (UTC)

Er...So where do NPs end and MDs begin?

Natalie Norem, RN has concerns:

1) there is a big difference between NP's and PA's (PA's are educated under a medical model, NP's educated under a nursing model)
2) NP's have more autonomy than the article gives them
3) NP's are definitely physician extenders, but they compliment physicians care and good looks —Preceding unsigned comment added by 165.20.104.30 (talk) 14:42, 29 January 2009 (UTC) 4) however their education is not uniform. People in the medical community are nervous that NPs feel they are equal to physicians. 5) Physician Assistant's education is more comprehensive and intensive than nurse practitioner's, No weekend, Afternoon, evening courses are available. No working while in school. Sorry all of you NPs who think you are oh so superior get over yourselves. —Preceding unsigned comment added by 76.111.167.251 (talk) 04:31, 7 June 2010 (UTC)

What is up with all of the People who try to make NPs sound as if they have equal training to physicians and PAs? We have great education and training but some people need to get over themselves and the limit to their role. There seems to be many NPs who feel because they have done their learned there job over the several years. The public needs to understand that the nursing "doctorate" is merely an academic degree and they should not be confused with medical doctors. - Susan, phD, aprn

Something the article really doesn't seem to answer (but instead leaves hanging): NPs, it sounds like, can do just about everything an MD can...So where the hell does an NP's scope of practice end and an MD's begin? --Penta 21:45, 25 September 2007 (UTC) THEY CAN NOT!!!

Actually, its more accurate to say that a NP can do everything a RN can do, plus a bit more (very true). The gap between the NP and MD/PA scope of practice is large, about what you would expect as the NP is only 1 year more training from the RN, while a MD does 4 years of medical school and then 3-7 years of residency and for specialists 1-3 years of fellowship. So, the 1 year difference in education between a RN and NP make them more similar than the 6-13 year difference in training between a NP and a MD. Also NP education is no where comparable to PA education. As PA education is full time training with only advanced courses. There is no such thing as counting an undergrad course in pharmacology and counting it as your graduate phamacology course the way some NP schools do it unlike Medical school and PA school. 129.82.217.44 (talk) 19:46, 23 December 2007 (UTC)

NPs and PA have the same scope/level of practice. They are the two "mid levels", only difference is the school track with NPs doing a nursing track and PAs doing a medicine track. —Preceding unsigned comment added by 129.176.151.7 (talk) 16:57, 9 February 2008 (UTC)

I would have to agree and disagree with much of the above.

its more accurate to say that a NP can do everything a RN can do, plus a bit more.

This is a fair statement. However the whole comparison between education of an NP to and MD is misleading. The education for an NP is not 1 year difference between and RN. Many RN's are Associate degree trained, in CA, US well over 50%. Though some are BSN's. A Current NP program requires an RN spend approx 2 years obtaining a masters degree. Then another year or more obtaining the NP certification. To top that, they are pushing the minimum requirement to be a DNP(Doctorate Nurse Practitioner). This will require another 12-18 months of education. The DNP is not designed to change the scope of practice for a NP however.
As for the differences between the scopes of practice of an NP VS MD, there is a large difference. A NP takes on your daily healthcare needs, though severe cases are often passed on to an MD. Also, you seldom see a Surgical NP, though they can be a first assist with proper training. The scope of practice between an PA and NP, though similar, is also different. PA and NP fill a similar notch; however they are governed by different boards. PA's under the AMA, the NP's under nursing boards. PA's must always be under the supervision of an MD, where as NP's has the authority to practice independently in 23 US states, often more rural states. Other states are considering legislation to grant NP's more freedom to practice. Also, the educational training is different for an NP and PA. PA can in some places, still be a diploma certification, though Associate and higher degrees are more the norm. In the US all current NP programs are Masters Degrees. Which means that an NP must also have a Bachelors degree, normally a BSN, though there are some exceptions? NP and PA's are not MD's, though they are more and more taking over the position of an Family practitioner MD, while many MD's go into More profitable specializations. So basically, a NP, is not a PA, is not a MD, but they all work together in their prospective fields to serve health care. —Preceding unsigned comment added by MWJamesLDS (talk • contribs) 17:27, 4 April 2008 (UTC)

In Colorado I have come by very few RNs that did not have a BSN, it would be interesting to see a comparision to the scope of practice from a PA and NP, in our state in common practice they seem to be identical. In regards to PAs, it was my understanding that diploma programs had been discontinued, and that all PA programs where now bachelors degree+2 years PA school, so very similar if not more than the BSN+1-2 year NP? —Preceding unsigned comment added by 67.132.98.55 (talk) 02:21, 24 June 2008 (UTC)

Late to the the conversation, but to answer, NPs are not physicians, so where NPs end and MDs begin is in 4 years of additional medical school education, 3-10 years of additional residency training, and optionally an additional 1-4 years of fellowship training. For people who want to be NPs, go to NP school. If you want to be an MD, go to medical school. Going to one and hoping for another is a recipie for an unhappy healthcare worker. In our practice NPs and PAs are identical, our hospital requires both to be supervised and work in collaboration with their physicians. In practice they do many of the same things that medical students rotating on our service will do, only on a full time basis and they are much more efficient than our students!~~ —Preceding unsigned comment added by 129.176.151.10 (talk) 19:49, 11 December 2008 (UTC) Here's for reading, I see my contribution is somewhat redundant!

1) Hopefully this helps?

Overview of NP Practice in the United States: http://www.acnpweb.org/i4a/pages/index.cfm?pageid=3465

Chart Overview of NP Scopes of Practice in the United States: http://www.acnpweb.org/files/public/UCSF_Chart_2007.pdf

2) Also, this statement is simply inaccurate:

"...where NPs end and MDs begin is in 4 years of additional medical school education, 3-10 years of additional residency training, and optionally an additional 1-4 years of fellowship training."

The undergraduate (pre-med) preparation for physicians is not at all clinical, and only about 2 years of medical school are truly clinical. MDs get a ton of basic science, but in undergrad this is mainly a weed-out process. Nursing education doesn't emphasize, for example, understanding the difference between SN1 reactions and SN2 reactions (undergrad organic chem) or being able to calculate the velocity of falling objects, because frankly, it doesn't matter when your patient is going south. Instead, the undergraduate curriculum for nursing students is clinical in nature, with relevant basic science and applied science. And though some RNs only did 2 year programs initially, all NP schools are grad schools and either require the 4 year degree prior to matriculation or they just include the extra education as part of a longer program. But all NP schools grant master's degrees at a minimum.

Most nurses also work for several years before starting grad school (most NP programs require it; even if it doesn't, most students feel they need the experience). On the med school clerkships just get students comfortable in the setting, comfortable with their physical assessment skills, comfortable with handling a code, etc., whereas most nurses have already been doing this stuff for years.

NP programs are specialty specific, e.g. family practice, adult acute care, pediatrics, women's health, oncology. So minimal time is spent on areas unrelated to the intended specialty, e.g. a Pediatric NP student does not spend an inordinate amount of time studying congestive heart failure or dementia. That doesn't mean they get a bad pediatric education, but it does mean that fewer years are required.

Regarding residency, most MDs do not have 9 years of residency and 3 years of fellowship. 3-5 of residency is typical; most do not do fellowships. Longer residencies are for surgeons and specialists; that doesn't make generalists bad or unsafe. Most residents would also tell you that after the first year, they feel that they are being exploited and underpaid, because they don't actually need that much hand-holding. NPs, as nurses who have worked with cohort after cohort of new interns and seasoned residents are aware of this, and while they know that the first year or two on the job will be brutal, they do end up as quite competent providers.71.242.234.90 (talk) 22:30, 20 February 2009 (UTC)Denise

Having read the large amount of talk here...I don't think anyone is arguing about competance of providers. It looks rather that there are 1 or 2 people who are arguing for a political agenda rather than wanting an accurate information page. Having worked as an RN, then an advanced practice nurse, and now in medicine after deciding to become the oldest woman to graduate from my medical school (!! now that sounds depressing!!) I can say that both doctors and nurse practitioners are very competent, but they do very different things and have VASTLY (I was surprised) different knowledge backgrounds. I actually kind of laugh when I think about comparing them, because they aren't the same and have different roles, and your right its not just about time being educated but rather what they are being educated, which is very different. Fuzbaby (talk) 14:15, 21 May 2009 (UTC)

Arguing that basic science education in medical school is pointless highlights your misunderstanding on how MDs and NPs differ. MDs are trained to form ddx from day 1 and you need to be able to have a strong background in the basic sciences (acid/base balance=chemistry, circulatory system=physics, protein structure=sickle cell, etc.) in order to do this. There is also a strong focus on EBM and how to ascertain/synthesize management strategies when clear evidence does not exist (eg prophylactic antibiotics in high risk SBP pts). TO argue that these aspects are worthless because they don't have immediate pertinence in emergency situations is ignoring the vast majority of medicine and how it progresses. If we all just continued to follow algorithms to keep people alive we would still be giving inotropes to people with CHF and resecting gastric adenocarcinomas. — Preceding unsigned comment added by 72.220.185.47 (talk) 06:15, 18 November 2011 (UTC)

Midlevel

Where I am from (Denver and Salt Lake City) they are called (by themself and others) mid level providers, to help indicate that they have more training and responsibilities than the RNs and also to denote that they are in between the level of care provided by an RN and a doc. Some patients get confused and don't understand the difference between a doc and their midlevel so it helps if clinics are upfront in telling them who/what they are and what their role is in their care. I'm going to change it to reflect in the article, if anyone else has thoughts please write them here instead of just reverting things.~~ —Preceding unsigned comment added by 129.176.151.10 (talk) 20:22, 21 December 2008 (UTC)

I am a midlevel provider in MN. Other than identifying us as PAs or NPs, this is the common terminnology. —Preceding unsigned comment added by 129.176.151.10 (talk) 17:37, 6 January 2009 (UTC)

RE: "mid-level"

This is a deragatory title bestowed by the AMA and their supporters implying that physcians are comparatively "high-level" (a claim inconsistent with published research on the quality comparison between NPs and physicians) and RNs as "low-level"? —Preceding unsigned comment added by 152.132.9.197 (talk) 01:18, 10 January 2009 (UTC)

If its how the practitioners describe themselves then how is it not appropriate to include in the article? You may believe it is 'deragatory', but I don't believe it is meant to imply anything other than that they are mid, or in between, an RN and a physician. It also emphasizes that they do not provide the same practice care level as a physician, it has nothing to do with "quality", though I doubt you have anything to back that up, but rather with scope of practice which I encourage you to read and educate yourself on. ChillyMD (talk) 01:58, 13 January 2009 (UTC)

Some links from a quick google search showing midlevel used in scholarly discourse both in the US and abroad to define NPs and PAs.

http://who.int/reproductive-health/hrp/policy_briefs/midlevel_hcproviders.pdf

http://www.aafp.org/online/en/home/practicemgt/specialtopics/mlpissues.html

http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=103623501.html

ChillyMD (talk) 15:04, 13 January 2009 (UTC)

ChillyMD, your statement NPs "do not provide the same practice care level as a physician" is prejudiced, and false. We went to nursing school because we acquiese with nursing philosophies. "Midlevel" as a term does not establish an accurate range of ANY training level, whether a RN or a physician or as you seem to push for your point of view, in between, an RN and a physician. Midlevel" is an outdated, limiting term, and prevents FNPs from relating to patients on THEIR level. What level are the patients ChillyMD - in between an RN or a physician? —Preceding unsigned comment added by 208.191.131.245 (talk) 00:56, 21 January 2009 (UTC)

You clearly missed the point. ChillyMD (talk) 15:54, 18 May 2009 (UTC)

PAs, NPs, CRNAs, are all defined by law as mid level healthcare providers [[1]]. This isn't even an argument. Fuzbaby (talk) 00:28, 16 June 2009 (UTC)

Your claim that "mid-level" is in between an RN and a physician is plainly wrong. A PA is not above an RN and certainly aren't "between" a nurse and physician - they are below a physician just like an MA in the medical hierarchy while an NP is above an RN in the nursing hierarchy. An NP is not below a physician any more than a pharmacist, physical therapist, chiropractor or audiologist is. NPs in many states are independent providers with a different focus on training (prevention and health instead of disease) that provide an identical standard of care to that of a physician in a similar practice environment. You cite physician sources to back your physician biased claim - that's like the Democrats citing Michael Moore to back a claim or the Republicans citing the Heritage Foundation - the source is inherently biased and must be discarded as unreliable. Perhaps you could review the literature instead of citing policy briefs that advocate a position. —Preceding unsigned comment added by 24.117.40.30 (talk) 02:20, 26 October 2009 (UTC)

==Independent== (a scary thought really) Thank you whoever removed the comments about NPs practicing independantly. In our state they practice under the supervision of a physician (like a PA does) and their scope of practice allows them to treat a number of common conditions without really having to do any consultation. This is not, however independant practice the way most people write it. I will look the source up again, but I think it was UCSF's nursing school published that in all 50 states they are required to work in collaboration, supervision, or some other word the state chooses (but not independant) that indicates more or less degrees of freedom, and all states clearly define that said practice is within the scope of their training (just like a PA, they can't go do things they aren't trained to do). ~~ —Preceding unsigned comment added by 129.176.151.10 (talk) 20:27, 21 December 2008 (UTC)

Re: Independent

While many states have mandatory "supervision" or "collaboration" requirements, 14 states have no such restriction for NPs and in those states NPs are in fact independent providers within the State Board of Nursing's stated Scope of Practice for Advanced Practice Nurses. Please link to or fully reference the document from UCSF so that it can be viewed by others. as for PAs, as I understand it they are required to be "supervised" by a physician in all 50 states. Thx. —Preceding unsigned comment added by 152.132.9.197 (talk) 01:16, 10 January 2009 (UTC)

All states describe a scope of practice, which is undebatebly different than that of an MD, and very similar to a PA. I think for the common consumer of healthcare they can think of the NP and the PA being very similar. A quick google search found this:

http://www.acnpweb.org/files/public/UCSF_Chart_2007.pdf

My read is that 10 states allow independant practice with somewhat less than that allowing independant prescription writing withing the scope defined by the state. Note: independant does not mean someone can do anything they want, implicit in any practice is working within a defined scope. In every day practice this can be anything between working alone in a minute clinic, to working as a physician extender in a busy multispecialty clinic, to working in a supervisory role above other nurses on a floor. One thing that has always made me recommend the NP/PA career path to students (who often don't think of pathways other than RN or MD) is not the depth of practice (I'm always upfront, if you want to be the final word in patient care, neither PA nor NP are "almost" or "just about like" an MD), but rather the breadth of practice, the shortern training pathways, and the ability to easily change between practice settings. ChillyMD (talk) 02:13, 13 January 2009 (UTC)

I am an NPP, many years of nursing education, and wholeheartedly disagree that we are not "almost" or "just about like" an MD. I dare you to provide AMA references which state NPs practicing in a hospital setting provide substandard care. Until you provide AMA references to back up your narcissistic claim above, these statements do not belong in this article. —Preceding unsigned comment added by FetktNPP (talk • contribs) 19:47, 20 January 2009 (UTC)

This has nothing to do with whether or not the care delivered is substandard; it's an issue of scope of practice. No-one is accusing NPs of providing substandard care. Basie (talk) 21:25, 20 January 2009 (UTC)

The references provided is not a matter of scope of practice issues. These are quality comparisons. Like I asked previously, ChillyMD needs to provide AMA quality comparisons to back up his POV, not scattered about quality comparisons. In outpatient settings I do not tell patients to call me "Midlevel." I am a "Nurse Practitioner." DNPs with full independent practice, owning their own outpatient clinics, aren't telling patients to call them "Midlevel." DNPs refer to themselves as "Nurse Practitioners."FetktNP (talk) 21:42, 20 January 2009 (UTC)

This article is about the level of training and functional role of Nurse Practitioners. We shouldn't make "quality comparisons" here because the quality of care provided depends on the competency of the individual providing it. The term "Mid-level" certainly does apply to training requirements. Maybe we can find some language & references that make it clear. (offtopic, and IMHO: anything which gets a patient more one-on-one facetime with a living, breathing health professional improves the quality of care immensely.) --Versageek 23:54, 20 January 2009 (UTC)

I was going to respond at length here, but I was informed that most of the deliberately provocative posts and problems with this page are from a single disruptive user. As already mentioned, the point I was making was about scope, and not about quality of care, and I'm not sure what the AMA has to do with anything. I am happy to work with both nurse practioners and physician assistants, I have found both to be very valuable in our group (in which they have identical roles). My wife is an academic biochemist (a PhD), and after her many years of schooling and research she is very good at what she does, which I understand very little of; similarly I would not expect her to go into work for me :-) ChillyMD (talk) 19:12, 28 January 2009 (UTC)

Tbere are many references supporting the care of NPs when compared to MDs. Buppert provides an excellent reference list for anyone interested. Selected studies include: - Mundinger, M.O. et. al. Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians. JAMA 283(1), January 5, 2000 - Aigner, M.J., Drew, S. & Phipps, J. (2004). A comparative study of nursing home resident outcomes between care provided by nurse practitioner/physicians versus physicians only. J Am Med Dir Assoc. 5 (1):16-23 - Lenz, E.R., Mundinger, M., Kane, R.L., Hopkins, S.C. & Lin, S.X. (2004). Primary Care outcomes in patients treated by nurse practitioners or physicians: two year follow up. Medical Care Research and Review. 61(3): 332-351 - Rudy, E.B., Davidson, L.J., Daly, B., Clochesy, J.M., Sereika, S., Baldisseri, M., Hravnak, M., Ross, T. & Ryan, C. (1998). Care activities and outcomes of patients cared for by acute care nurse practitioners, physician assistants, and resident physicians: a comparison. Am J. Crit Care. 7(4):267-281 - Sox, H.C. (1979). Quality of patient care by nurse practitioners and physician assistants’: a ten year perspective. Ann Intern Med. 91:459-468. - Spitzer, W.O., Sackett, D.L., Sibley J.C., et al. (1974). The Burlington randomized trial of the nurse practitioners. New England J. Med. 290:251-256. - Wardrope, J. & Rothwell, S. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. J Accid Emerg Med. 17(4): 290-291. 204.120.161.4 (talk) 22:25, 26 May 2009 (UTC) proud to be an NP

• how is any of that relevant to the this topic? Its all talking about NPs working with MDs, AS NPs; which is not what a small minority of NPs in the United States are arguing for. Fuzbaby (talk) 21:33, 27 May 2009 (UTC)

• • NPs work as NPs and provide a quality of care equivalent to that of a physician within their specialty (Ibid - Mundinger et al 2000 and Lenz et al 2004). On top of that, the standard of care rendered by a Nurse Practitioner, Nurse Anesthetist, and Nurse Mid-Wife are identical to that of a Family Practice Physician, Anesthesiologist, and Obstetrician respectively according to the courts. The relevance is related to independence (the title of this section) and the patently false claims by physicians and their minions that NPs do not work independently or that they are "mid-levels" (again a derogatory term employed by the AMA to claim superiority in all things healthcare related) that require "supervision" (in my state this is little more than a farce since there are NP owned and operated practice and there is no physician that sees the patient, reviews the chart, or practices in the office). In contrast, the PA is not independent and requires "supervision" in all 50 states. The claim that the "mid-level" reference is in regard to education is equally absurd since physicians get only two years of instruction followed by two years of clinical rotations and then a protected environment for OJT paid at taxpayer expense (i.e. residency). In contrast NPs have six to eight years of combined didactic and clinical education with no benefit of a protected practice upon graduation. As for the subject matter they study - it is very different and I'm sure that anyone who looks critically at both programs will agree - the education is different and the approach is different, not that one is less than the other, only that they are different with different foci. That doesn't change the reality that in many states NPs can and do practice independently and to claim otherwise is to perpetuate a lie. —Preceding unsigned comment added by 24.117.40.30 (talk) 01:38, 26 October 2009 (UTC)

Removal of list formatting in Post Nominal Initials?

Please explain why the list formatting was removed here. Thanks. Proofreader77 (talk) 21:24, 21 December 2008 (UTC) I see it has been restored. Proofreader77 (talk) 21:54, 21 December 2008 (UTC)

I think that the long list of post nominal initials looks like a terrible alphabet soup. Is there a better way to format this? —Preceding unsigned comment added by 128.172.28.45 (talk) 18:10, 19 March 2009 (UTC)

WP:NURSE priority review

As part of a review of all nursing wikiproject articles, I have changed this article's importance to high per Wikipedia:WikiProject Nursing/Assessment#Importance scale. I have also added B class. If you disagree, please leave a note here so we can discuss it. Cheers, Basie (talk) 04:18, 23 January 2009 (UTC)

This section skips around a lot and is confusing. Plus minor edits/spell check. How about this:

Education, board certification, and licensing (United States)

To be educated as a nurse practitioner, the candidate must first complete the education, training, and licensing necessary to be a registered nurse (RN).

Note that the educational level of RNs is highly variable in the US: candidates may take the RN licensing exam after completion of either of three types of programs: a 4-year Bachelor of Science in Nursing (BSN) program, a 2-year Associate's Degree in Nursing (ADN) program, or in some states, a hospital diploma program. The commonality is that, upon completion of the program, all candidates must pass the licensing exam (NCLEX-RN) in order to become RNs and practice nursing.

Nurse practitioner programs currently offered in the US are at either the masters degree (or post-master's) level (MSN), or the doctoral degree (DNP) level. NP programs deal with the varied educational levels of RNs by either requiring the BSN (bachelor's degree in nursing) prior to matriculation, or by offering some type of "bridge program" for those with ADNs or diplomas. Most also require one or more years of work experience as an RN prior to matriculation. NP programs are typically specialty-specific, e.g. family health, adult health, adult acute care, pediatric acute care, women's health, oncology, etc., and many programs may expect that the RN-level work experience is relevant to the desired specialty, e.g. pediatrics, ICU, labor-and-delivery, oncology, etc.

Upon successful completion of the MSN (or DNP) program, all candidates must pass the appropriate board certification. (As recently as the mid 2000s, not all states required board certification; this is now required in all 50 states.) The two largest certifying bodies, the American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners (AANP), currently require an MSN degree (or post-master's certificate) prior to taking the board certification exam. In 2015 these organizations will require a DNP for a candidate to be eligible to take the certification examination.

Several organizations oversee certification, including the following:

• American Association of Critical-Care Nurses
  
• American Psychiatric Nursing Association
  
• Board of Certification for Emergency Nursing
  
• Pediatric Nursing Certification Board
  
• National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties
  
• Oncology Nursing Certification Corporation
  

In order to legally practice, the NP must then be licensed by the state in which he or she plans to practice. The state boards of nursing regulate nurse practitioners, and each state has its own licensing and certification criteria. Re-licensing criteria also vary by state; some require biennial relicensing, others require triennial, and the number of required continuing education (CE) credits varies.

The variety of educational, certification, and licensing paths for NPs is a result of the history of the field. In 1965, the nurse practitioner profession was instituted and required a master's degree. In the late 1960s into the 1970s, predictions of a physician shortage increased funding and attendance in nurse practitioner programs. During the 1970s, the NP requirements relaxed to include continuing education programs, which helped accommodate the demand for NPs. Today all certifying organizations, states, and employers require a minimum of a master's degree for new NPs, and all states require board certification and licensure (already established NPs with lesser education were grandfathered in). —Preceding unsigned comment added by 71.242.234.90 (talk) 21:02, 20 February 2009 (UTC)

Rephrase please

The article starts out:

A Nurse Practitioner (NP) is a registered nurse who....

That's a bit ridiculous. Would you say:

A dentist is a college graduate (BA or BS) who....

How about:

A Nurse Practitioner (NP) is a master's degree prepared health care provider. NPs build on their education and experience as a registered nurse (RN) with an advanced nursing education that includes training in the diagnosis and management of common as well as complex medical conditions. They are board certified and licenced to practice by each state. Nurse Practitioners provide a broad range of health care services and can be found in family practice clinics, specialty clinics, emergency departments, hospitals, ICUs, and more.

Nurse Practitioners are considered "mid-level providers" or "physician extenders," by many physicians and hospitals, although this label is controversial, since NPs are completely independent practitioners in many states, and in many settings provide equivalent care to that of physicians.^1,2,3,4,5

1. Brown, S., & Grimes, D. (1993). Nurse practitioners and certified nurse-midwives: A meta-analysis of studies on nurses in primary care roles. Washington, DC: American Nurse Publishing.
2. Burns, M., Moores, P., & Breslin, E. (1996). Outcomes research: Contemporary issues and historical significance for nurse practitioners. American Academy of Nursing Practice, 8(3), 107-112.
3. Crosby, F., Ventura, M. R., & Feldman, J. J. (1987). Future research recommendations for establishing NP effectiveness. Nurse Practitioner, 12, 75- 79.
4. Spitzer, W. O., Sackett, D. L., Sibley, J. C., Roberts, R. S., Gent, M., Kergin, D. J., Hackett, B. C., & Olynich, A. (1974). The Burlington Randomized Trial of the nurse practitioner. The New England Journal of Medicine, 290(5), 251-256.
5. U. S. Congress, Office of Technology Assessment (1986). Nurse practitioners, physician assistants, and certified nurse-midwives: A policy analysis. Washington, DC: U. S. Government Printing Office.

see also: Gwen D Sherwood, Mary Brown, Vaunette Fay, Diane Wardell: Defining Nurse Practitioner Scope of Practice: Expanding Primary Care Services. The Internet Journal of Advanced Nursing Practice. 1997. Volume 1 Number 2. Available at: http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijanp/vol1n2/scope.xml

71.242.234.90 (talk) 23:06, 20 February 2009 (UTC)Denise

I don't agree that you provided an accurate rewrite. I am an RN and work with physicians and NPs. Any NP who claimed to be independant and work as a physician, or who puts themselves forward as a physician or just like one would be rightefully fired from our practice for misrepresentation and likely lose their license with our state. Equivalent care WITHIN their scope of practice, maybe, but an NP doing say a lumbar tap would be just as horrible as a firefighter/emt offering to surgically remove your spleen. Wow, the amount of BS on this talk page is amazing, and as a nurse I'm ashamed to think that some of it my be written by some people who are my collegues (or by others with agendas).

• It is accurate and many NPs are in fact independent - your state maybe not, but in my state they absolutely are. As for an NP doing an LP - absolutely it is within my scope and within my training, as are laceration repairs, I&Ds, biopsies, and many office based or outpatient procedures. Not only that but the NIH definition of an NP includes LPs specifically http://www.nlm.nih.gov/medlineplus/ency/article/001934.htm . Now, if an NP poses as a physician, they are wrong and subject to legal action just as a physician posing as a nurse or NP would be for misrepresentation; claiming to be independent (in my state), providing services that are similar to that of a physician (in most states), and meet the identical standard of care of a physician within their specialty or they are obligated to refer (in all 50 states and the U.S. territories) are all accurate and are not misrepresentations at all. —Preceding unsigned comment added by 24.117.40.30 (talk) 01:57, 26 October 2009 (UTC)

An RN can do an LP if they are specially trained, just like an NP or PA. They CAN't just because they went to NP/PA school. Can they interpret those results and do something about it? Absolutely: its called a physician referral. And an FYI, some paramedic skills are outside of the scope of practice for an NP or PA, so by the same argument you could say paramedics do similar work and at a similar level to an NP/PA. However, anyone who is non biased and with inside understanding of healthcare will know they operate in different roles/levels. 129.176.151.10 (talk) 03:51, 25 April 2010 (UTC)

"Identical standard of care" is not possible, as by definition they are providing a lower level of care (as is any "mid level").129.176.151.10 (talk) 04:39, 28 April 2010 (UTC)

Criticism

This article entirely ignores the raging turf battles between physicians and nurse practitioners that is currently going on in the US and that has been going on for quite some time. I have started a criticisms section to shed some light on this topic. There is a lot more information out there regarding this that I hope to add soon. The absence of such a section is a pretty big elephant in the room. Ctoensing (talk) 18:18, 19 March 2009 (UTC)

Its part of the NP agenda to say they can practice independently, yet deliberately leave out what their scope of practice is. I happen to be a licensed pilot, and can fly an aircraft by myself. That doesn't mean I'm certified to fly a 747...but hey, if no one asks...I won't tell!

I do agree though, this article is poor from the standpoint of it being 'informative'. —Preceding unsigned comment added by 129.176.151.10 (talk) 15:42, 18 May 2009 (UTC)

mmm..about dnp programs. they aren't doctor programs, they are geared more like an Ed'D program. i.e. help create better nurse educator. If you don't know what an Ed'D is, think a PhD only without the intense research focus. Cheers. Fuzbaby (talk) 14:18, 21 May 2009 (UTC)

That's not true - DNP is a clinical doctorate, PhD programs are for teachers and researchers. Sapphiremind (talk) 02:54, 27 December 2010 (UTC)

• • last time I checked, the "D" in DNP stood for "doctorate", level of education and not a profession. Claiming that it isn't a "doctor program" is like Coke claiming that Pepsi "isn't a cola because it isn't our brand of cola". Is the DNP a physician program? No (semantics? yes, but then when I was in school words actually had meanings), is a physician program a physical therapy program? No. Is a physical therapy program a nuclear physics program? No. Is a Nuclear physics program an Education Theory program? No. Is an Education theory program an Audiology program? No. See, there's a trend; having a doctoral degree makes you a doctor of whatever you studied. The professional titles are physician and Nurse Practitioner, the education for the DNP, MD, DO, PharmD, DPT, EdD, PsyD, PhD, OD, et al makes them all "doctor". —Preceding unsigned comment added by 24.117.40.30 (talk) 02:06, 26 October 2009 (UTC)

You would be the type of person they market towards. Anything can be called a 'doctorate program' these days as long as you call it such. Doctorate and non doctorate NPs have identical training, that usually lasts about a year and a half, and is at the same level as PA school (master's level). A very small number get doctorates that are education orientated and are true doctorates. I can see how from outside of the education world they could be confused...but in reality "most" DNP programs are simply master programs relabeled so schools can charge more and students there can have bigger egos than at traditional NP schools. 207.229.236.211 (talk) 16:49, 5 April 2010 (UTC)

last time I checked, the "D" in DNP stood for "doctorate", level of education and not a profession. Claiming that it isn't a "doctor program" is like Coke claiming that Pepsi "isn't a cola because it isn't our brand of cola". Is the DNP a physician program? No (semantics? yes, but then when I was in school words actually had meanings), is a physician program a physical therapy program? No. Is a physical therapy program a nuclear physics program? No. Is a Nuclear physics program an Education Theory program? No. Is an Education theory program an Audiology program? No. See, there's a trend; having a doctoral degree makes you a doctor of whatever you studied. The professional titles are physician and Nurse Practitioner, the education for the DNP, MD, DO, PharmD, DPT, EdD, PsyD, PhD, OD, et al. —Preceding unsigned comment added by 149.68.105.221 (talk) 22:41, 8 April 2010 (UTC)

In reality, nursing schools can put a "D" in front of anyting they want. If I offered a program called "doctor of gas station refilling" and had a 1 year course in how to fill up different cars, would that be an equiv degree to other doctoral programs? No? GUESS WHAT??!? IT is the educational content that MATTERS. The sad thing is its patients who lose because of unethical practitioners who try to claim they have the training of physicians, when in reality "DNPs" have no more training than any other NP; and as mid level providers have on average 6-10 year less training than a physician. Its certainly NOT semantics, in fact a DNP (or their equivalent NPs or PAs) claiming to be a physician can lose his/her license and be subject to criminal prosecution. As a PhD, the doctor title has become largely useless, as its used by many schools to describe non rigorous educational programs. 129.176.151.10 (talk) 03:46, 25 April 2010 (UTC)

And yet, thanks to evidence-based practice, study and people scrutinizing NPs, we've discovered they have just as good, if not better outcomes than physicians. That's why they're so popular. Sapphiremind (talk) 09:45, 4 March 2011 (UTC)

To the person inventing the degree of "doctor of gas station refilling" -- you obviously have never gone to graduate school and have no understanding of university structure. No school of anything can just call a program a doctorate degree. Doctorate programs are created and certified under the rules of the graduate school of a University. If a school has managed to put together a new doctorate (such as the DNP) it only can be put into place if it meets the appropriate rigor of such doctorate level graduate education. Certainly, nurses are not given any special favoritism here, indeed since they have often not been part of the "old boys club" nurses and nursing programs often have to prove themselves that they are truly "worthy" of such titles -- and that it seems is the undercurrent of all discussion here ... 64.184.170.110 (talk) 08:46, 30 January 2011 (UTC)

DNP programs exist so that NPs can feel better about themselves and superior to the equally trained Physician Assistants (PAs), and NP schools can charge twice as much tuition for the same amount of time in school.

There has always been talk of academic inflation in any of these fields newly requiring a doctorate (such as physical therapy, nursing, etc), but I will say one thing - whenever I've worked at a hospital with a nurse who had a PhD/DNS/DNP, we never addressed him or her as "Dr (so and so)," nor did they call themselves as such. In a healthcare setting, especially a hospital, to use the term "doctor" will almost always cause the patient to believe you are an MD or DO. We've always addressed them as "Nurse (so and so)," as the word "doctor" carries too much meaning in healthcare to allow its use in the academically correct fashion. Nominally and legally, however, I will recognize them as possessing a "doctorate degree," even though I may NOT be of the opinion that one doctorate degree is as rigorous, difficult, useful, or accessible as another. —Preceding unsigned comment added by 71.61.204.168 (talk) 00:01, 24 May 2010 (UTC)

NPOV

{{editsemiprotected}}

please add the banner {{globalize/US}}

76.66.203.200 (talk) 11:17, 26 June 2009 (UTC)

Not done: {{edit protected}} is not required for edits to unprotected pages, or pending changes protected pages. I've changed it for you. — Martin (MSGJ · talk) 13:05, 26 June 2009 (UTC)

Reinstatement of edits reverted...

...by Megasloth at 1am 4th Feb 2010

Dear IP user,

I left a note on yout IP talk page, which I note you acknowledged by blanking the page. Please can we enter discussion of these edits? All my reversions were either simple grammatical issues, or issues of Wikipedia guidelines and style. If you believe your changes are warranted, please start a discussion per WP:BRD. Many thanks, --MegaSloth (talk) 01:25, 4 February 2010 (UTC)

this person is a banned sockpuppet who evades bans to vandalize this and a few other articles. they should be reported for vandalism and reverted Theserialcomma (talk) 01:48, 4 February 2010 (UTC)

Comparing

I found this article to be comparing an NP to a Physician Assistant and should really only be compared to a Physician. It was bashing the NP and lifting the PA up above the NP when in reality the NP has more rights and independence than the PA. Don't get me wrong, there are many good PA providers but to consistently say the NP isn't as good as a PA is wrong. — Preceding unsigned comment added by 24.213.249.202 (talk) 20:44, 6 July 2011 (UTC)

This is subject to debate. For one, the term "mid-level provider" is used by many sources, including those outside of the field of medicine, to describe PAs, AAs and ARNPs. Many facilities use NPs and PAs interchangeably. Saying either one is better than the other, framing it as a matter of fact rather an an ongoing debate is misleading. Phltosfo (talk) 20:17, 13 October 2011 (UTC)

NP's are designed to practice autonomously whereas PAs are not. "Mid-level" used as defined as sub-physician is not an appropriate use of the term in relation to APRN's, Dentists or other equivalently trained clinician, and is a term going out of style for all associations outside of MD affiliated ones. Rivard.M (talk) 18:26, 29 August 2012 (UTC)

Fundamental quality issues

This article seems to be of very low quality. The scope of practice is a non-specific list that is meaningless to the average user. The practice settings section is almost totally irrelevant -- it names nearly every type of facility in which health care of any sort is delivered. The post-nomial credentials section is also irrelevant to the average user. The ones of importance are really APRN,BC and NP-C. Also, it doesn't talk about any of the criticisms of the profession, giving a very one sided view of the profession. Phltosfo (talk) 20:17, 13 October 2011 (UTC)

The Doctorate of Nursing Practice (DNP) is NOT required in 2015. This is only a recommendation by the AACN. The only way for this recommendation to be enforced is for all state BON to require this and/or for all schools to get rid of their MSN programs (of note, two of the most prestigious graduate nursing programs, UCSF and UPenn don't have any plans for this). — Preceding unsigned comment added by 207.96.13.12 (talk) 20:21, 5 January 2013 (UTC)

Substantial growth can be expected in the nurse practitioner field, specifically pertaining to the Affordable Health Care Act in the USA, with the increased emphasis on primary medical care, which many would agree was de-emphasized, to some degree before the passage of this act. Similar growth can be expected in the field of physician assistants and medical schools may move toward more extensive primary physician preparation. Discussion of these matters should be included in this article.

Nurse practitioners (as well as medical professionals in a very parallel role) are often the primary medical functionary in many areas of the world beyond the scope of western medicine's hierarchy and supervision. It would seem highly appropriate to include an overview of this activity from some organization, such as the World Health Organization or other non-governmental agencies in this field. A summation of this activity (as well as any projection of expected changes and improvements) would be a valued inclusion, here. — Preceding unsigned comment added by 68.97.87.243 (talk) 18:39, 5 January 2014 (UTC)

Poor Reflection

There are many inconsistencies and possible erroneous facts in this article, not to mention the writing is of poor quality. For these reasons, it does not reflect well upon NPs. I stumbled upon this article while trying to discern the difference between the scope of practice of physicians and NPs in the United States, and this article fell way short of all of my expectations. For example, early on the article suggests that NPs are licensed through state medical boards, but in the United States section, it says that NPs are licensed through a national board. Is it state, national, or both? Since it seems to vary by state, further research into each state's requirements is necessary to clarify the board certification requirements.

This article seems to suggest that NPs have similar powers and responsibilities as physicians, but have received much less training. Furthermore, the implied inconsistencies in certification requirements give less credibility to the field, as the education, training, and board certification requirements for physicians do not vary by state.

I strongly suggest that this article be totally revamped by a currently practicing NP.

70.197.69.34 (talk) 06:36, 26 May 2013 (UTC)

Image in lead

I removed the image File:Canberra Hospital Walk-in centre staff at work. (5567045104).jpg from the article's lead because it didn't actually do anything to illustrate the concept of a nurse practitioner. The image was since reinstated in this edit (with no explanation), so I'm starting discussion here. — Preceding signed comment added by Cymru.lass (talk • contribs) 04:23, 31 July 2013 (UTC)

Increased Need in US Section

Putting aside the heavy US focus, this entire section is going too far for what credible sources offer. Some of it reads like a promotional piece for NPs, and statements like " As a result of this extreme need for NPs, they are also expected to receive more autonomy, meaning that nurse practitioners would be able to fill the traditional primary care role like a physician would" are not supported. It seems to be a speculation made by the writer by drawing lines from articles discussing primary care shortages to opinion pieces advocating expanded NP scope of practice. Maybe it can be rewritten well, but I'd say it would be best to cut this whole section. Stick the current practice rights in the US section, and if US job projections are important, find somewhere to put that, but otherwise this section just seems too subjective and speculative. — Preceding unsigned comment added by 107.214.136.181 (talk) 07:03, 21 May 2014 (UTC)

Ann Intern Med

doi:10.7326/M13-2567 - review of nurse management of chronic conditions. JFW | T@lk 12:22, 20 July 2014 (UTC)

Philosophical Orientation of the Article

There is an implicit assumption of a kind of "medicine supremacy" as though in 4000-6000 years of human history it would be impossible that a new discipline emerges that aims for a more holistic examination of the human health and illness experience. One can happily defer to physician colleagues in concerns especially suited to their comprehension of the "matter" of humanity, but this deference does not connote "ownership" in the classic hegemonic sense. The article can acknowledge the the emergence of complexity in human health and disease may require networked models of care with the social and economic benefits that attend. A philosophically and editorially balanced article doesn't view the topic from the standpoint of a discipline specific frame of reference. It is the equivalent of saying that physics is "better" than chemistry. They both use equations. Similarly physicians and nurse practitioners both use aspects of medicine. Physicians extend that to its logical epistemological conclusion; nurse practitioners incorporate some of medicine into a fabric of that discipline's own design. They are aiming for a different conclusion.