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Eight Facts about Nurse Practitioners for Patients

Eight Facts about Nurse Practitioners for Patients

If you recently added a nurse practitioner to your medical practice, you may be experiencing some resistance among patients to utilize the new provider for their care.

Next time patients express reservations, take time to educate and inform them about the nurse practitioner's background, experience, and expertise.

Here are eight key facts about NPs (from the American Association of Nurse Practitioners) that may help guide you through these conversations.

For more information on incorporating nurse practitioners into your practice, view "Healthcare Scope of Practice Debates Continue."

Click here to view the slides in PDF format.

Physicians Practice


NPs are perfectly trained to handle the majority of primary care issues and when something is unfamiliar, we consult with a physician, psychologist, dietician, NP, PA, pharmacist, optometrist or other appropriate professional. As far as NPs ordering unnecessary tests, I would like to see the evidence supporting that statement. We all have different experiences with different providers and it is unfair to lump every person of a profession into one category, that alludes to discrimination. Times have changed and technology and education have grown to accommodate progress, why can't we? NPs and physicians are educated and trained somewhat differently so comparing length of education is seemingly irrelevant. All NPs must complete a "residency" or clinical hours, albeit, not as many as physicians but NPs are not trying to be physicians. NPs are trying to be NPs and care for patients, not take the place of physicians. NPs are advanced practice nurses with graduate degrees and are responsible for their own actions in addition to being quite capable providers. I love working with my physician colleagues, even though I work alone oftentimes.

Beth @

I appreciate your comments. May I ask if you can really equate NP online training programs to the actual clinical training done by medical students and residents? I struggle to even begin to compare, and I was a nurse before going to med school.

Sally @

I appreciate your comments. May I ask if you can really equate NP online training programs to the actual clinical training done by medical students and residents? I struggle to even begin to compare, and I was a nurse before going to med school.

Sally @

I know that we have a shortage of Docs in this country but does it mean that we OK with a substandard medical care. It is all about patients. They deserve good quality medical care. It means a correct diagnosis and treatment. I am a family doctor but my son has his pediatric doc with 4 year of med school and 3 years of training in pediatrics. My delivery was with obstetrician with 4 years of med school and 4 years of OB/Gyn residency. She needed 2 minutes to evaluate me and to make a decision that I needed C-section. From decision to delivery it took 10 minutes in total.
If I have a dog. It will be treated by a veterinarian doc.
Before practicing here I practiced in 2 European countries and perhaps I have been spoiled.
I do not know what is the reason behind it ; Government -not anticipating the PCP's, shortage or not providing financial support for med students or insurance companies cheapness or....
Scio Me Nihil Scire- I know that I know nothing. The more you know the more humble you would become.
I know that I am a doctor of medicine and also surgeon here. Do you want you appendix to be removed by me or perhaps by somebody after five years of training in surgery?

Ewa @

What makes you think NP's are trying to be surgeons? That's not even an option. How about shutting your little pie hole and posting some statistics backing your theory that NP's provide substandard care? Do you mean they have worse outcomes than MD's? Simply not true.

What do you propose as a solution for the large number of people in this country who don't have access to Primary Care because there aren't enough providers?

S @

Well, I was an RN, BSN trained, summa cum laude and worked 4 years in an SICU setting before returning to school...medical school. I have no regrets on that decision and have to say that there are places for NPs and PAs, but it is not as an independent clinician.

I am sorry, but the training simply does not equate. It just doesn't, no matter how much mid-level practitioners think or say it does. And the idea that one can become an independently practicing NP with an online degree program is mind-boggling and says everything in a nutshell about what is wrong in the nursing community on this issue. Becoming a good diagnositician (as in a good H&P and formulating a differential diagnosis) happens by seeing lots of patients and developing that "gut" feeling about what you are evaluating, not referring to protocols and sending out for CT scans.

And snide comments about going to school longer to become "gods" with inflated egos does not help the conversation or the collaboration amongst our disciplines.

Sally @

What's the point ? Medics did this many years ago and so !?!?

Ira @

What part of the "Healthcare Team" did I miss here. Aren't we a part of a team that main objective is improved patient care. I've been in the medical field for approx. 43 yrs. starting out as a paramedic and moving through the ranks. I've seen good and bad providers regardless of their credentials. Please, let's focus on our mutual objective of patient care.

ED @

Well said!

rebecca @

whine all you want. Np's and pa's are here to stay. Blame it on health care costs, insufficient primary care physicians or whatever you want. The bottom line is there is a role for everyone in caring for patients. Np's and pa's can effectively handle the majority of primary care patients. The ones they can't, they refer to md's. That is the future role of the md, the supervisor. Like it or not it is the future. That is why md's will continue to get paid substantially more than np's or pa's. If you are unhappy about the future of your chosen role you should've done your research before spending excessive amounts of money and 7+ years of your life.

rebecca @

there were no CNP's when i chose medicine. yes i am a dinosaur. i was a preceptor for the first class of CNP's from my institution. i was proud to be a leader. i regret it now.
i practiced high quality medicine in urgent care for many years. i loved the challenge and the diversity. with cost concerns, local urgent care facilities now rely on CNP and midlevels. i found alternate employment. yes i am bitter. i trained my own replacements. it smarts.
the local CNP's are excellent and know the limits of their own expertise. I think is is likely, however, that the overall healthcare savings will be diminished by specialty referrals-- to a dermatologist for poison ivy, to a gyn for a pelvic exam, to an ophthamologist for an uncomplicated corneal abrasion, etc.

judith @

the 3 inappropriate referrals to which i alluded are real examples i personally oserved. what part of my observation is ignorant, i wonder?

judith @

NPs can be good for practices, especially large ones to help reduce workload

Maicie @

Physicians need to let the NP "Doctors" of nursing sink or swim on their own merits. Don't back them up. Seeing the undifferentiated patient is not simple. They have the same outcomes as doctors most of the time, because let's face it, most of the time we as physicians have little effect on outcome. They even tout studies where they have BETTER outcomes, because in general they slough anything hard onto the physicians.

As a physician who practices in the ER, and sees the dirty laundry and experiences the boucebacks and dumps of the other "providers" of all stripes, I can tell you with certainty that the most eggregious errors of omission and comission come from the NP's (and CNMW's). The more aggressive they are about their ability to practice "Independently," the further down the path their errors get and the tougher they are to clean up when they become apparent.

We make our money on the volume of patients we see, but we EARN it on the ones with the difficult presentations that may be subtle. Experience and training matters. Pan-scans and shotgun-labs are not the answer to deficiencies of knowledge.

Geoff @

What a ridiculous and arrogant remark; "they slough anything hard onto the physicians." In my opinion, that is exactly what should be done. It is totally appropriate for NPs to refer complex patients to a physician. Otherwise, I feel confident your remarks would be more concerned with the NP practicing beyond their scope, or "independently." I'm certainly glad I don't have to collaborate with you. I would never let a cohort "sink" if I could teach them or guide them in some way!

rebecca @

In my state, NP's can practice independently. They also have a knack for being called "Dr." - since now all NP programs are conferring a doctorate of nursing . . .

I have many years of experience collaborating with midlevels in a myriad of settings - whether they be 18D Army medics, Navy corpsmen, IDC/Independent Duty Corpsmen, PA's, NP's, Nurse Midwives, and residents at all levels of training.

I can tell you with some certainty that the most ridiculous and arrogant things I have seen lately have been by relatively freshly minted NP's, who don't know what they don't know, and have gotten away with things one too many times, and whose preceptors were limited and not stellar teachers.

I could tell you about a half a dozen cases off the top of my head that resulted in bad outcomes or could have, that independently practicing NP's have mishandled. I can also rest assured that my next shift I will see several patients sent in by the same "providers" to the ER for a CT of their head they bumped on a cabinet, that really need a neuro exam and a head injury sheet and reassurance, or a CT of their belly when they need a BRAT diet and a f/u plan, or sent for an MRI of their knee when what they need is a knee exam, immobilizer, and followup. I'm not kidding, a month ago an NP sent a patient to the ER for a knee injury, I asked if she did a Lachman's and McMurray's or they were guarding too much, she said, "What's that?" Same one sent a patient with "rectal bleeding" to the ER - not comfortable doing a rectal exam.

These people want to play doctor - until it gets hard or confusing. Their collaborating MD's/ preceptors do no precepting - they do a cursory chart review and collect a percentage of the take. I don't get paid to precept them. And when they can't be bothered to call me on someone they are sending in, and won't admit that they don't know what to do, and want to be treated as an equal as opposed to a subordinate . . . well, if it's arrogant to call bullshit on them, then I guess I'll wear that badge with honor.

Midlevels are obviously here to stay, but they need to be careful what they wish for. Primary care and urgent care are hard, dirty, often thankless jobs. They can have it. But lets not pretend they are doctor equivalents. They aren't.

Geoff @

I have to say, it goes both ways. I've worked in the medical field for 17 years now-10 as a RN and 7 as a trauma and surgery NP. Most recently, I was a patient with a 6cm Meningioma. I had a brain MRI 2 years ago and a Duke, fellowship trained neuroradiologist missed my tumor the when it was 2.5cm. For the first 24hrs after I saw the tumor on MRI, we thought it was malignant since it was categorized as fast growing (because it "wasn't there" 2 years ago). This miss caused my surgery to be quite a bit longer than the anticipated length required to remove it 2 years ago. It took 12 hrs this sept to remove it after my temporal lobe had grown over it. As a trauma NP-I pick up on radiology misses-all the time. I can think of dozens of missed injuries by the radiologists-most recently a 70 yo emphysemic pt in a mvc. I saw her on rounds the morning after her admission the night before. All scans had been read as nml and she c/o a significant amount of right chest pain. I looked at her scans again and she had 8 acute rib fx and a sternal fx. I came to a trauma in progress and found the ED doc having problems with their chest tube insertion. I looked and they were putting it in backwards-open end first. Oops my point being there are great doctors and shitty ones. There are great NPs and there are shitty ones. It truly goes both ways.

rebecca @

It's appalling the level of ignorance her from someone supposed to be a professional..
The sad thing is is that there is turf protection which is what seems to be going on here... In all truth of the matter, it's amazing how many patients seek out the care of an NP because of the poor outcomes and mistakes made by physicians! Get off your high horse and give your head a shake. Comments like yours are purely disgusting

rebecca @

"I've worked in the medical field for 17 years now-10 as a RN and 7 as a trauma and surgery NP"

Explains your defensiveness.
I agree with your above comment - there are good and bad doctors, and good and bad NP's.

What you probably won't admit, is that there are on average more bad NP's!!

Anyone who "seeks out the care of an NP" vs. an MD in general because they are worried about poor outcomes and mistakes deserves what they get. Specific NP's and specific MD's, sure, pick based on your likes and reputation. But what most Noctors don't want to admit, is that they are lesser trained, doctor-wannabees. Don't take your insecurities out on me, Dr. Nurse.

I'm out.

Geoff @

Why do physicians feel so threatened by NP's? They are providing access to care for those who would otherwise not see anyone or those that the physicians are not willing to see. I would think we could put aside the petty ego and personal agenda's long enough to try and be patient-centered and team oriented here. The patients deserve it.

Deneen @

You keep posting stories about how wonderful NPs and PAs are and they ARE wonderful assistants when they do what their training and experience allow, BUT they often go way beyond the scope of their training and work as doctors, but without the proper credentials for doing this and without supervision.

We all see problems with the care these people provide especially when they do not know what disease the patient has and they order many, often expensive, tests to try to find the diagnosis and they try this medicine or that one without having the ability to properly decide the diagnosis and correct treatment.

You seem to be an advocate for NPs and PAs and I understand that they are valuable helpers but they should not be promoted as doctor-equivalents, which they are not.

Why not focus on their job as a valuable assistant, giving an honest evaluation of what they do (or should or should not do) so that the public can decide if they want to be seen by them or a physician.

A doctorate in these fields does not make them a physician.

Patients often tell me that they wanted to bring their child, with 104 fever, to the doctor, but that he is booked for 2 weeks and cannot see this emergency patient. BUT the NP or PA can see the baby TODAY.

These are the very practices that love their assistants and often say they are even better than they, the physician.

Why not have an honest discussion of the role these people should have in health care, not a laudatory, self-promoting agenda.

Your presentations imply a special interest in promoting the work of these people, not an honest, unbiased evaluation, discussing the problems with the care they provide.

Danziger @

...and this is what is wrong with healthcare and why it is so difficult to fix in America. Thank you for the fine, condescending commentary Danzinger.

Deneen @

All very interesting . . . but mostly irrelevant. Those factoids are of interest to NPs, and people considering becoming NPs. On the other hand, a patient wants to know: "Is this person fully capable of figuring out what's wrong with me and knowing what needs to be done to help me?" That's not answered in the slides above. We see that they generally have the authority to prescribe medicine. That they have master's or doctoral degrees. But: Are they a competent substitute for (or in some cases even better than) a physician? That's what patients want to know.

Donald @

Why bothering to go to medical school!

Stanley @

So that you have time to inflate your ego and overestimate your worth! It takes time to become a "god."

Deneen @


"It takes time to inflate your ego and become a "god", is one of the most divisive and arrogant statements I have ever heard in dealing with this collaboration issue. No, it takes all that time to learn, observe, study, listen, and then one finds out that they don`t know all they need to know to do the job that they have trained for over the past 10-12 years. At least one who goes through undergrad, med school, and then a 4-5 year residency "knows" that they don`t have all the answers. Many of the APRNs with whom I deal don`t know what they don`t know.......these people are dangerous! During the past 2 weeks I have gotten 3 referrals from the ER with heavy vaginal bleeding, Hgb of anywhere between 4-6, and all sicker than hell. All had had a CT, CBC, CMP, and various other lab, but not one of the APRNs who sent them had bothered to remove clothing and do a physical exam. "Some of these APRNs are just as good as PCP physicians"!!!! Can any physician here describe what would have happened to them during training if they presented a patient at grand rounds with the complaint of massive vaginal bleeding, but a physical exam had not been done? Let`s see now, was the bleeding vaginal or rectal? Uh, I don`t know because I didn`t do an exam! Wow! Why not? Well I did a CT, CBC, and CMP instead? I can`t even imagine the storm that would have come down on the presenting student, intern, or resident.

Training isn`t the same, thought processes are not the same, and obviously many of these APRNs are not held to a standard of care that is hammered home 24 hours a day all through med school and residency. I do not know how most of these APRNs are trained, but I have seen residents have to stand in front of 60-100 people at a grand rounds and get brow beaten, laughed at, and severely chastised for errors in a work-up that came nowhere close to not doing an exam on a bleeding patient. Anyone having failed to do an exam would have simply been dismessed from the program on the spot. Oh, but I forgot, APRNs do not have ANY physician input into their training....do they.

Charles @

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