Talk:Nurse practitioner

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)

"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.

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)

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 not 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)

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)

Actually, its more accurate to say that a NP can do everything a RN can do, plus a bit more. The gap between the NP and MD scope of practice (or PA and MD) 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. 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?

http://www.acnpweb.org/i4a/pages/index.cfm?pageid=3465

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

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)

Independent

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)

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)

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