Dear California, About those NPs

Dear California,

The California Medical Association is correct in opposing the AB-890 Nurse practitioners: scope of practice: practice without standardized procedures. While I am not a California resident or physician, I am a former nurse practitioner (NP) and I can tell you firsthand that NPs are ill-prepared for independent practice in medicine. Even when I was an NP, I never supported this. The reason, medical school is medical school, NP school is nursing school. 

Compared to medical school, my NP school barely scratched the surface in terms of the molecular, genetic, and biochemical pathophysiological basis of disease. But that is the inherent difference in education. Whereby medical school education teaches the fundamentals of medicine down to the molecular, genetic, and biochemical level, NP school teaches advance practice nursing. Nursing as defined by the American Nurses Association is the diagnoses and treatment of human responses to actual and/or potential health problems. If nursing is nursing and medicine is medicine, the advance practice registered nurse (APRN) – of which NP is categorized, is hybrid somewhere in the middle. Educated in nursing theory to practice in the medical model. Although I was taught that I was practicing advance practice nursing, in reality, I was expected to practice medicine with a 2 ½ years of a master’s degree program. See the problem with that? The NP education is not set up for the practice of medicine. 

Medical school teaches the medical decision-making process, whereby NP school teaches the nursing process. When as an NP and I made a medical diagnosis, I was practicing medicine as an NP and was not practicing nursing. This part of the big lie being told. Nursing will argue that NP’s are in-fact practicing advance practice nursing, but that’s a crapshoot. When I would diagnose schizophrenia and prescribe abilify as a psychiatric NP, I crossed lanes from the nursing lane into the medical lane and practiced medicine. How could I be educated in one model and one discipline and be expected to practice in the other discipline for which I had no exposure, education, or experience? And then do so with no oversight from that discipline as being proposed in AB-890?

Speaking of experience. As an NP, I had 15 yrs of nursing experience as a registered nurse (RN) in psychiatry before becoming an NP. I always practiced on physician lead teams as an NP, the way it was intended for more seasoned RN’s to work under physician supervision/collaboration. NP’s often tout this nuring experience as a reason to be able to practice medicine. But I say non-sense. Having been educated in the medical model and the medical decision-making process in medical school, I can see the error of thinking experience in one discipline qualifies you to practice in another discipline. Sure, I knew the names of all the drugs and psychiatric diagnoses, but it was practicing nursing and not practicing medicine. That experience was nursing experience, and not medical experience. In other words, knowing a few facts is not the same as being educated in the thinking process of the other discipline. The nursing process and the medical-decision making process are vastly different. If a painter suddenly decided they were qualified to do plumbing because they are both working in the same house, wouldn’t you want your plumber overseeing the painter doing plumbing? 

Apples and oranges folks. You’re being lied to by groups with an agenda for full practice authority FPA. This bill is nothing more than a lobby sponsored rouse by political groups seeking FPA. It has nothing to do with the health of the people in California. I support The California Medical Association and am against AB-890. 

Robert Duprey MD

Robert is a 2nd career physician (MD); a combat Veteran with the US Army; a former psychiatric nurse practitioner; an independent researcher; a medical writer; and now having passed USMLE Steps 1, 2CK, 2CS, and 3, is a residency applicant.

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4 Responses

  1. Gary Pearce MD says:

    I am in Florida…..NP’s are independent here. Does anyone really believe this will drive down the cost of health care???? Oh yeah, I forgot that NP’s will not have that crushing educational debt. Now it seems to make sense that anyone interested in primary care would be smarter to do it via the NP route- cheaper, faster, and the patients don’t know the difference. IT IS A SCARY WORLD WE ARE ENTERING.

  2. Stephen Rockower, MD says:

    The nurses are well organized. Why aren’t we as organized? Because so few docs belong to the CMA. It takes better organization to fight this crap, and we have done a poor job fighting with each other. If you’re in California, CMSdocs.org is the place to start. If you’re in another state, don’t think they aren’t coming after you next. JOIN your local and State medical societies and specialty medical societies and the AMA to fight this scourge. “If You’re in Medicine, You’re in Politics” said one doc. We need to do this!

  3. arthur gindin says:

    Couldn,t be more clear!

  4. Rick says:

    Very seriously lobbying occurring to pass this bill. You can only imagine. As was stated in this blog previously, the goal is for the insurers to take over every aspect of health care. This is just the next logical baby step.
    It is alarming.

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