Living Across State Lines as a Family Nurse Practitioner: The Koolaid is the Same

This is not a blog about bashing the hubris of Mr. Cody Yochum. He’s probably a great guy just taking advantage of opportunities that avail themselves to him. He doesn’t know what he doesn’t know. I can’t write about his experience in nursing. I can only write about mine as a former RN for 15 years then NP for 8 before becoming an MD. This is more about the ‘kool aid’:

 “Even in the ICU, NP care is equal to or better than what is provided by physicians. I do central lines, arterial lines, intubations —even hemodialysis lines. I’m able to do procedures that attending physicians can’t.”

How often do we see this sort of sentiment these days? Heck, when I was a new nurse practitioner I believed it too. Got my first prescription pad, and that was confirmation that I was the bomb. I even thought I could park on the physician’s parking spaces. I thought I was equal. I didn’t know the difference. I didn’t know what I didn’t know. The notion of equality and even superiority was the ‘koolaid’ being fed even at early stages in my nursing career. Afterall, I could ‘do’ everything the physicians could do in my field. What I was missing was threefold: (a) understanding the notion that ‘doing’ things does not a physician make, (b) understanding of the vast difference in educational preparation between the NP and MD, and (c) comparing nursing with medicine is like comparing apples to oranges – a fallacy. 

‘Doing’ things as a marker of physician equality is a farce. However, throughout my nursing career, it is rampant. I mean, certified nursing assistants (CNAs) can ‘do’ many things a licensed practical nurse (LPN) can ‘do’. Are they equal or superior? No, just different. The LPNs resent the notion of equality. The LPN’s can ‘do’ many things an associate degree RNs (ADN) can ‘do.’ Are they equal or superior? No, just different. The ADNs reject and resent the notion. The ADNs can ‘do’ many things a bachelors prepared RN (BSN) can ‘do.’ Are they equal or superior? No, just different. The BSNs reject and resent the notion. The BSN’s often have years more bedside clinical experience to the nurse practitioner (NP). Are they equal or superior? No, just different. The NP’s resent and reject this notion. The NP’s can ‘do’ many of the same tasks and MD/DO and do. Are they equal or superior? No, just different. MD/DOs reject and resent this notion. MD/DOs can save lives with almost devine care. Are they equal or superior to God? No, just different. Get the point? What one ‘does’ or can ‘do’ is not a marker of equality or superiority. 

In terms of educational preparation, CNAs are different from LPNs; LPNs are different from ADNs; ADNs are different from BSNs; BSN’s are different from masters prepared nurses (MSNs/NP/CRNAs etc); MSNs are different from doctor of nursing practice (DNP); DNP is different from MD/DO. There is neither inferiority, equality, nor superiority amongst degree types. Just different with different roles and functions and educational preparation. Let me illustrate from my own experience. My MSN curriculum was 650 clinical hours in the program. One semester of ‘advanced pathophysiology,’ called physiological concepts for nursing. In this semester course, week 3 was cardiovascular (CVS).  Required reading was 3 chapters from Copstead, L-E. C., & Banasik, J. L. (2005). Pathophysiology (3rd. Ed.), St. Louis, MO: Elsevier Saunders. In summary, 1 week on the CVS with 3 chapters. Now my medical school curriculum was about 4-5000 clinical hours. The pre-clinical 1st & 2nd years were foundational sciences and system based modules with one system module on the cardiovascular system alone. Week 1 alone was on chest pain. Required week 1 reading was: Gray’s Anatomy for Students, Chapter 3 Thorax, Heart section; Guyton & Hall Medical Physiology, 5 chapters; Robbins and Cotran Pathologic Basis of Disease, Ch 12 (The heart); Rang and Dale’s Pharmacology, Ch 21 (The heart); Goldman’s Cecil Medicine, 3 chapters. In summary, an entire 8 week module on the CVS with 11 chapters per week. 

In terms of comparing nursing to the practice of medicine. This is a fallacy. I recently wrote about this in another Authentic Medicine blog (3). I won’t rehash that again here, but suffice to say, can you really compare apples to oranges?

Have a great day

REFERENCES:

  1. https://news.illinoisstate.edu/2019/10/living-across-state-lines-as-a-family-nurse-practitioner/?fbclid=IwAR1tUwTEf3Bz45R81HkU_ou15X1MJVuuXYBSIcQFFX7otUAJCcODrCrmVFE
  2. https://nursing.illinoisstate.edu/100-years/The-Flame-2018-19_web.pdf
  3. https://authenticmedicine.com/the-apples-oranges-fallacy-comparing-hospitalist-resident-to-hospitalist-midlevel-practitioner-team-performance-with-the-banana-factor/
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