A 🧵 ~
As #nursePractitioners we must take a stand and say enough is enough. #FPA will continue to ruin our profession in many ways. Here is one way: forcing unprepared NPs into FPA to be marketable in today’s job market. /1
Over the last 10-15 years Nurse Practitioner educational standards have become less rigorous. Online schools rely heavily on paper writing versus hands on clinical learning, yet the drive for FPA has continued at full speed. /2
Some will state that “their school was just fine, very rigorous, with high quality education that taught them to practice at the top of their education. What is the “top of our education” and why do we equate it with FPA? /3
What is it in the NP education that makes us eligible for independence after 2-3 years of didactic and then 500-1000 hours practicum versus a physicians med school and residency - even with transitional practice states we are not close to the hours physicians put in. /4
If we were truly ready for FPA there would not be numerous Facebook groups full of practice questions including how to read and interpret labs, what books to buy to understand diseases, patient examples that stump the practitioner. /5
The argument will be made, “we shouldn’t have to pay a physician so we can do our jobs,” - I ask you, why should a physician take on added liabilities & work for free?
Employers will feel the same way, why pay a physician and why employ NPs who do not have FPA? /6
So now we get to the crux of an issue with FPA - jobs. In a state with FPA or Transitional Practice it is cheaper to employ NPs, and large companies will use this to their advantage. Keeping only the minimum physicians on staff, not hiring non-FPA NP’s, /7
And running centers with clinicians who were not meant to be independently running centers without a physician on board. We see this model already with some companies - anything to save money without considering the cost to the patients. /8
In the end it’s not about “being allowed to practice at the top of my education” (which each state defines differently), it’s about the quality of care, and it’s about safe care. It’s about our patients who depend on us to always do the right thing. /9
Let’s hope we can look back in 10 years and say this was the point where we as a profession, took a stand - we said Enough is Enough, Patients Matter More than FPA. / end
People have asked why I have “flipped” from a advocate of FPA to a advocate of Physician led team care. Although I have explained it several times, I am going to do it ONE last time for everyone to read. Please read carefully. /1
I have always been an advocate of safe care. Patients come first, always. Their needs outweigh my needs. Always. It’s been that way since day one. Since I first called myself a nursing student. That has not changed and will not change. /2
I used to be an advocate for Full Practice authority. I believed that nurse practitioners were every bit as capable as caring for patients on the same level as a physician, providing the same care, and that we were simply being held back by physicians and legislators, /3
Who defines the practice of NPs? You would think it would be other healthcare professionals. Instead it is legislation & money. When a NP states they "want to practice at the top of their scope" or "not have restrictions on their license to practice" that NP is sadly repeating /1
Rhetoric that lobbiestst use to change the scope of practice. Fact is, if the NP is following the rules set forth in their state they are practicing at the top of their education and utilizing all skills/scope that their boards approve them to use.
Please remember that.
/2
Next time you see a NP lobbying for increased scope, increased practice rights, etc.
There is a reason the original laws were put into place. The profession was created to work with a physician-- not on our own. /end
Today, I will ask my supervising physician what he thinks of independent practice for nurse practitioners. I will tell you his unfiltered response later today. Stay tuned!! #nursepractitioner#MedTwitter
Ok, here is the answer.
"I think it depends on the competency of the NP-but Primary Care isn't easy & shouldn't be thought of as easy. There needs to be a mandatory competency test prior to a NP working independently even after 20-years, just to make sure everyone is on /1
The same level. We have to be fair to our patients and provide high quality care across the board. Nurse Practitioners are usually more empathetic with patients, take time to connect with patients, and thus have happier patients - but the care needs to be equal. /2
Why doesn’t @AANP_NEWS address the education issues going on with today’s NP schools? We know you are not the accreditation board, but you do advocate for FPA around the country. How can AANP in good faith continue to advocate for FPA when NP schools appear to be getting worse /1
As a major association for all nurse practitioners shouldn’t AANP be advocating to clean up our educational programs first, before seeking to allow new grads FPA? Wouldn’t it benefit the entire profession to refocus efforts on strengthening our standards? /2
As a FNP I am worried about our profession. As a preceptor I witnessed numerous ethical issues with students in relation to their studies, Multiple students taking tests together, cameras covered in lockdown browsers, test banks being shared - and /3
My tweet was meant to highlight my views on the failings of NP schools and training as is now in the U.S. I do not agree with diploma mill schools that offer 100% acceptance rates, force students to find their own preceptors often at hefty fees, and /2
Prep the NP student so much with practice boards, they have likely seen very similar questions by the time they take their test. Because for these schools, certification rates are how they measure success - not if their students get well rounded education. /3
Today, the Dr. I work for stood up for me again.
Patient: We drove all this way, we don't want to see you, we want the doctor.
Me: OK, you will see the doctor but can I ask you just a few questions first to help him?
Patient: NO! Get the doctor we don't want to see a nurse.. /1
Me: Yes, I will go get him right now.
Me to Dr: They would like to see you, and do not wish to even speak with me, a nurse.
Dr: You told them you are a Nurse Practitioner, right?
Me: Of course, right when I introduced myself...
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Dr: Well, let's go - you are coming with me and I will tell them that if they behave like this again they can find a new doctor.
We walk into the room.
Patient: HI Dr. I am really glad to see you.
Dr: Did you tell my nurse practitioner that you would not talk to her?
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