Make sure you know your patients well. I suggest that two professionals practicing within the same scope of practice should be certified by the same standards. In the comments section anonymous responds.
I think you're missing the point here. NPs will practice advanced clinical nursing skills not medicine. So I don't think your argument that NPs be certified to the "same standard" is valid.
This is a new one for me. I guess I'm practicing nursing then. I had no idea that a 78 year old with chronically uncontrolled DM, chronically uncontrolled HTN, AFib, chronic systolic heart failure, CAD, hypothyroidism, 3V CABG, COPD, OSA, chronic stasis edema, immobility and super morbid obesity who comes into the "primary care" nurse practitioner clinic with a complaint of dizziness and shortness of breath was going to get an "advanced clinical nursing skills" evaluation and not a medical evaluation.
I stand corrected. Please excuse me for my ignorance. Now please explain to me how you plan on evaluating the patient without employing the process of the medical differential diagnosis, the part you say you don't do. I'm curious beyond all belief on how advanced clinical nursing skills will solve the answer of why grandma is dizzy and short of breath from an advanced clinical nursing skill set.
Are you going to tell her everything is OK and give her a hug? That seems to be the mantra of NPs who claim compassion trumps the all unimportant "medicine" as you call it. Or do you just send them to the ED to get a medical evaluation by a doctor and wait for your next patient, the healthy 50 year old man with hypertension.
If you're not practicing medicine, perhaps you should let your patients know as well. And Medicare and Medicaid. And all other insurance companies as well. The E&M codes you bill are certainly medical evaluation codes. Remember the third component is "medical decision making", not advanced clinical nursing skills evaluations.
This is the one thing that I cannot agree with the NP's on. The greatest bullsh*t that has ever been presented in medicine is that NP's are practicing "advanced nursing practice". Sorry, but nurses don't formulate differentials, order tests, prescribe medications. What nurses do do is invaluable, and a great nurse makes life so, SO much better. But as an NP, you are practicing MEDICINE. Not nursing.
ReplyDeleteFor once Happy, you and I are in COMPLETE agreement.
Wow, things are a changing folks! Here is the really freaky part Happy and PA, commercial insurance, Medicare etc. is probably gonna love working PA/NP's into the mix and is going to begin to want patients to "ask first" for approval to see MDs soon for some things... and that my friends is so nuts that I bet it happens!
ReplyDelete-Second career nursing student
...Happy, it is the forest not the trees. You keep getting hung up in the trees!
ReplyDelete-Second career nursing student
NPs and PAs practice medicine, just without the "higher" knowledge of the physician. But that doesn't mean they aren't needed. Do nurses bring something extra to the table? Maybe, depending on their background. I look at a patient from several different "angles," some which might be different from yours.
ReplyDeleteSo yes, I admit I practice some medicine. It's fascinating stuff (psych) what with all the hypothetical actions of drugs given to address symptoms hypothetically caused by certain brain circuits.