re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187

And then tell me this. Do you think it's deceptive to use the name family nurse practitioner which sounds incredibly close to Family Practitioner (which is an MD) and then to wear a long white coat and hang your doctorate on the wall and lobby to independently manage a clinic of patients without doing medical school or family medicine residency? That just seems to me deceptive and like trying to steal the family doctors profession without the training to safely manage the full spectrum of pathology in the clinic

Thanks. It was out of educational interest. Not a defense of the quoted NP...

It works in Alaska. NP's are stand alone providers. I guess since many areas are so remote, they use NP's and PA's alot.

The 2000 hours is like maybe 1/6 of the shortest residency program (3 years). It's like cutting an intern (who did not do med school and didn't take all the classes) loose at Christmas to go practice out in a rural area by himself. I can't advocate for that as a safe idea

Heck there's not even any way to know nowadays how that would work. Nobody leaves an intern completely alone without any level of supervision at all half way thru the year so what that would even look like isn't known. And not to mention there is an innate average difference in reasoning ability and scientific knowledge between an average nurse and average doctor

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I know 2000 clinical hours doesn't compare to med school or residency but it's something.

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It's approximately the number of hours of the 3rd head clerk ships at LSU New Orleans Med (1800). Don't confuse the physicians here thinking NPs are "uneducated med school rejects" with "people who knew where they were at after 2000 hours of clinical training, which was very, very far away from being a solo practitioner."

As many have said- NPs are invaluable. you guys are often great at your job. That said, you just simply aren't ready for practice without oversight after 2000 collaborative hours in a part-time, mostly outpatient setting. Heck, after ~6000 hours (~3,000 in school, an additional 3,000 as an intern) in a mostly inpatient setting in tertiary centers, I'll meet the requirements on paper to apply for an unrestricted license, but I'll be the first to tell you that i would be a fool to hang my own shingle without a more experienced partner to back me up.
But even more importantly- I recent discussion with a member of the LA state licensing board, they're actually considering holding the issuing of licenses until a residency is completed because a disproportionate amount of complaints the board gets is from physicians who are licensed without having completed a residency. So not only are we talking about ~4x the amount of clinical contact in school (I read 750h frequently for NP) + 1.5x the number of hours required for the licenses in discussion, but the board issuing the licenses is considering RAISING those numbers significantly. Now, not to diminish any collaborative agreement or schooling or anything about the NP training that occurs (I've even trained alongside a few very good ones), I'm failing to see how that training can possibly be so much more efficient than that which goes on in residency so that after 2000 hours, they/you are ready to practice on your own.

A second, bigger issue, which was the same issue I had with the Optometry bill two years ago is that the state is now going to allow nurses and optometrists (old news) to practice medicine (the act of administering healthcare on your own accord without receiving those orders from someone else with a license) without a medical license. There's already one (now two) boards in existence to maintain standards and hold those administering healthcare accountable for their actions. They even require those practicing with a medical license to be held to the standard of a board certified professional in that field. This is something that, as the bill stands, will not be true of the nurses who will begin practicing medicine. Their oversight will be an entirely different board, the board of nursing as opposed to the board of medicine. Now, I'll admit, I haven't read their standards. But I'm fairly certain they're those standards will not be the same, because they insist that practice without oversight by a nurse practitioner is "under the scope of nursing." I disagree. I don't disagree because NP are bumbling idiots. I disagree because intentionally offering "tiers" of medicine is a bad idea, and regular Joes aren't going to know the difference.





Or in short:
No one thinks NPs are inept. They think that physician oversight is necessary.

Will this Bill get me some pink medicine when my kid has an ear infection before faster than having to wait 24 hrs to see the doc? if so, I'm IN

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approved to work in these rural shortage areas

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Have you seen the areas of Louisiana that are designated rural and shortage areas? It's practically the entire state. [img]new.dhh.louisiana.gov/assets/oph/pcrh/pcrh/hpsa/PC_MAP.jpg[/img]

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Will this Bill get me some pink medicine when my kid has an ear infection before faster than having to wait 24 hrs to see the doc? if so, I'm IN

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This bill will not create more nurse practitioners. This bill will only allow them to practice without a physician reviewing their charts/work. You can already see a nurse practitioner of PA, often on short notice. This just removes someone looking over their shoulder.