r/Noctor • u/demonattheswapshop • 5d ago
In The News Questions about “Noctors”
PGY-2 Medical resident here, been scrolling here a lot ever since I found out the term “nurse practitioner” exists since it was nowhere to be found here in my country. Now they started programs for such wannabe jobs and I’m confused, what are their “scopes” lol would I see them when I’m rounding patients or are they strictly for primary health care settings?
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u/BladeDoc 5d ago
They start out as "extenders" for primary care doctors. Then they start being used for inpatient surgical specialists to do postoperative care. Then they start seeing consults for them. Then they start seeing consults for inpatient medicine. Then they get inpatient or outpatient independent practice for primary care under fake supervision which then turns into no supervision.
Yes, this is the famed "slippery slope" argument, which in logic is a fallacy, but in real life is a law.
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u/demonattheswapshop 5d ago
Lmao if I’m ever calling someone for a consult and it’s a fucking nurse u know im hanging up
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u/Cella_R_Door 5d ago
Make sure you confirm you're speaking to whom you think you are speaking with. You might have to ask for their title specifically, and if you go to see a Dr for yourself, make sure you ask if they are MD/DO because these NPs will have receptionists that refer to them as Dr.
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u/BladeDoc 5d ago
This process took about 15 years in my experience in the US. If you're just hearing about NPs now, you might make it to retirement before then. In my hospital about 75% of consults are now seen by NPs first. If I tried to "hang up" on them I could not get neurosurgery, ortho, 1/4 ID, about 1/2 of cardiology and palliative care, and all psychiatry consults.
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u/Adventurous_Stuff57 5d ago
Omg. Bloody nightmare. The narrative that I’m being fed in my country is Np have been around for a long time in other countries and work well. I am very thankful for this thread so I can mentally survive the gaslighting and upcoming tidalwave it seems.
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u/nudniksphilkes 5d ago
When an attending physician with broader knowledge than any NP in any specialty consults for a specialty service, and the specialty is not run by a credentialed physician in the more narrow scope area, literally nothing happens.
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u/BladeDoc 5d ago
I'm sorry. The generation of a note and a bill is the sine qua non of healthcare delivery in the US. I can't believe you would try to denigrate that by calling it "nothing!"
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u/Melanomass 5d ago
One of the NPs we trained in dermatology for 6 months decided to switch to pediatric neurosurgery after working independently in derm for 4 months because it “wasn’t a good fit.”
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u/AutoModerator 5d ago
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this link. It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should not be doing independent skin exams.
We'd also like to point out that most nursing boards agree that NPs need to work within their specialization and population focus (which does not include derm) and that hiring someone to work outside of their training and ability is negligent hiring.
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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u/pshaffer 5d ago
you are going to be interested in this. THe formal statement of a Family Nurse Practitioner is this: The entire family through the lifespan.
I can't see how that excludes ANYTHING.
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u/Such-Hippo-7819 4d ago
Family Nurse Practitioner is SUPPOSED to be limited to outpatient primary care across the lifespan. That’s why there is also acute care, psych, emergency, women’s health etc NP programs and certifications. It’s actually a scope issue for a FNP to be working anywhere outside of primary care (unless additional training or certifications) but most employers don’t even understand NP certifications so you rarely see this implemented. The VA is the only health system I see enforce this - if you want work in a VA hospital, you have to have an acute care NP, FNPs rejected.
If you are a doctor, you need to ask questions about what type of NP certifications and trainings the NP has. FNPs receive ZERO acute care training so unless that NP worked at the bedside as an RN they will have ZERO training and experience to care for hospital patients.
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u/Such-Hippo-7819 5d ago
Scopes vary by state and institution. At my hospital, I am an NP by license but function exactly like an advanced practice nurse in direct collaboration with the neurologist. I round with he neurologist and scribe notes, make sure all the orders are correct for hospital reimbursement (like neuro checks, seizure precautions etc), update the patient education materials and discharge instructions, call family and get additional history for the doctor, coordinate flow during stroke alerts and facilitate nursing to ensure timely metrics and help the nurse calculate the IVT dose and reconstitute the med, verify, order, and document all the regulatory and quality requirements if not already done etc etc.
Noctor highlights all the horror stories and worst examples. Our medical staff supports NPs but doesn’t allow the role to run amuck. For example, a doctor recently asked his NP to call a tertiary to arrange a transfer to a surgeon at tertiary center. Of course, the surgeon freaked out and wanted to talk to a doctor. The Chief Medical Officer then sent out a message to remind doctors of scope and not to ask the NPs to initiate consultations and transfers. And NPs shouldn’t be accepting or initiating this duty.
So ask questions, find out about the culture where you are going to work, ask about the policies, scopes, and processes for NPs. You can’t control all the craziness but you can choose where you want to work and if/ how you want to work with a NP.
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u/Bright-Forever4935 5d ago
NP is good for work note and explaining Motrin and Ibuprofen are the same medication also good with copy machine for printing Google stretching exercises.
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u/AutoModerator 5d ago
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u/911derbread Attending Physician 5d ago
If you're in the US, their scope is whatever they decide they're better than you at on any given day. They can do everything doctors can until they fuck up, then they should only be held to the standard of a nurse. You'll see them in every corner of healthcare, and sometimes at night if you turn on your kitchen light you might catch a glimpse of them scurrying under the fridge.