Author: Rebekah Bernard MD

Shortly after the publication of Independent practice: Both nurse practitioners and physicians should be outraged (January 5), the Nurse Practitioner (NP) leadership responded with a press release, denouncing the concerns that were cited, calling them “rhetoric.”

But in contrast to this criticism from the political end of the NP spectrum, I was inundated by emails from working NPs across the country in support of the article.

Since the NP leadership requested a response, I can’t think of a better one than to present them with the words of their own constituents.  In fact, in reading these comments they may find that they themselves are the ones “out of touch with the realities of health care delivery today.”

Many of Today’s Nurse Practitioners Don’t Want Independent, Unsupervised Medical Practice

I am a young NP and have long been an outspoken opponent against independent practice.  There is certainly enough work for all of us, and it scares and angers me that schools and professional NP societies are tarnishing our reputations in the changes they pursue.     -Ryan, NP in Pennsylvania

I read your article and so appreciated your approach to the issue and agree with many of your points. I, too, have patient safety first at the heart of my practice and do not believe independent practice is the ideal.  I also agree that we are now pushing unqualified and largely clinically unsupervised nurses through cyber-programs that have no interest in failing a poorly prepared candidate.       -Pam, Acute Care Nurse Practitioner

Collaborative agreements help ensure physician involvement in patient care

In their press release, the American Association of Nurse Practitioners (AANP) leadership argues that NPs are being held back by physicians.  The AANP is particularly critical of collaborative agreements, decrying them as “financial vehicles designed to profit physicians.”  But many NPs wrote to me expressing their appreciation for such arrangements.

Some newer Nurse Practitioners recognize there is still much to learn

I enjoy the collaborative nature of practicing under a physician and believe the strengths of an NP or PA are best utilized in that format. The strength of an intelligent person is knowing one’s limits.     -Ryan, NP in Pennsylvania

The fact of the matter is that I don’t want to practice without a doc. This isn’t an ego game, and I feel that many NPs (along with our professional organizations) are making it into such.  -Brian, in his last semester of NP school at the University of South Alabama, who was an Emergency Department and ICU nure for a decade prior

Seasoned Nurse Practitioners value a physician relationship

As a veteran nurse of 34 years and an Acute Care Nurse Practitioner for 11 years, I am fortunate to be in a wonderful collaborative practice at a community hospital in the suburbs of Chicago. I never take for granted the value of the physicians who dedicated their lives to medical school. I consider myself to be an old nurse with sharp physical assessment skills, a drive to always push myself to know more, but I will never believe my training is equal to a physician. Keep up your fight for the safety of all mankind, for some day we will occupy those critical care beds too.  -Sherri, NP in Illinois

I agree and appreciate you voicing the reality of the difference in MD vs NP training. I feel that I had excellent University-based training, but it could never be equated to a residency. I feel I was trained to supplement/extend the physician care, not take its place.  -Mary, self-described “old” NP, 20 years’ experience, one of Central Louisiana’s first NPs

I do NOT want complete autonomy; I do want collaboration with my physician cohorts. -Carol, Family Nurse Practitioner in Tennessee, nearly 30 years of nursing experience in every area before attending a brick-and-mortar NP program

Decreased quality of Nurse Practitioner education is something we cannot ignore

The AANP press release had little response to one of the biggest concerns listed in my article:  the decreased quality of NP education.  This is something that working NPs and students wrote me about.

Current NPs are worried about programs accepting students without nursing experience:

I am appalled at the NP schools requiring no RN experience for admission. I was an RN for 23 years and still found the shift to NP a total paradigm shift. -Mary, NP from Louisiana

When I began my program, there was a 22-year old girl who had not yet even sat for her RN licensure. I was astounded. -Pam, Acute Care Nurse Practitioner in Illinois

Citing a colleague who recently graduated from the direct entry Vanderbilt program, Carol, the FNP from Tennessee wrote:

Every nurse and non-nurse that can fog a mirror wants to go to NP school and can just about get accepted by one if the money is right. ‘Here is $65K; Ok, here is your diploma.’ -Carol, Family Nurse Practitioner in Tennessee, talking about a colleague who recently graduated from the direct entry NP program at Vanderbilt

Doug, a DNP student at a “well-respected brick and mortar institution” wrote:

We need to stop these all online programs, which I refer to as ‘fly-by-night’ practitioner programs… I hate to see nurses with no experience or 1-2 years with a BSN and very little work experience allowed in NP or DNP programs. Unfortunately, this is what is happening. -Doug, Doctor of Nursing Practice-DNP-student at a “well-respected brick-and-mortar institution”

I could not agree with you more. Most of the [online] colleges will never match medical school training and hours dedicated to becoming a physician. My son is attending medical school.  As a mother of a med student and as an RN trying to obtain my NP certificate, I understand your views. -M.R., a Family Nurse Practitioner currently attending an online program

The AANP doesn’t really want to work together, it seems

The AANP press release concluded with a call to work together to increase access to health care.  Perhaps they should take their cue from Sherry, ACNP, who wrote:

Thank you for expressing your outrage with the state of healthcare with the projected shortage of physician providers. It is terribly unfortunate to watch the profession of nursing mass-produce nurses, and then allow these novice nurses to enter advanced practice programs that have limited curriculum to prepare them to care for patients without supervising physicians, much less independently.

The NP leadership would be well-served to listen to its constituents, who are gravely suffering under their policies.  

The NP status meant something at one time; no more. I sincerely wish I had remained an RN. I feel like I must struggle for my identity now. -Carol, Nurse Practitioner in Tennessee

Rebekah Bernard is a family physician and the author of How to Be a Rock Star Doctor:  The Complete Guide to Taking Back Control of Your Life and Your Profession.  She can be reached at her self-titled site, Rebekah Bernard, MD.