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Laws Preventing Nurse Practitioners from full practice authority:

Should mid-levels be able to practice without guidance?


Certainly there should be some concern when it comes to new nurse practitioners or new physician assistant (also known as mid-levels) graduates initially practicing without guidance.



When you graduate, you land jobs that pay you at a lower rate, and although this gradually increases with experience, I’m sure it’s not nearly your worth. You barely have the support you would expect in these new jobs, and training includes 30 minutes to 8hrs max for any new job. Training will not go beyond that first day that’s for sure.

The first job I ever had, I met with the doctor a few days prior to starting to  go over some ground rules with some quick training on how to write an actual prescription and a few diagnoses. My actual first workday I was all alone the entire shift in the office with my secretary, medical billers, office manager, and medical assistant.

I saw about 18 patients in 5 hours, I was so scared, I had no clue what happened or what I did, but I went home and did a lot of reading and came in the next day with a game plan. It went on that way, and I learned more and more each day from my persistence and perseverance. I would call the doctor when I truly didn’t know what to do and she would tell me what to do on the phone. I did learn this way believe it or not.

With subsequent jobs, you may initially be given a minimal patient load, which may last for the first few days, but after the first week the bomb will definitely fall down, and you will see the reality of practicing as a mid-level provider.

Let’s talk numbers, first few days a patient load of about 6 patients to help you orient to new job, then the load was anywhere from 12-20 patients. One job had an expectation that you are done with those 12-20 patients by 3pm sharp and head straight to the emergency room to do admissions until 7pm; a constant uncomfortable rush is what I would call it, dangerous when you are still learning.

Duties also included helping the doctor with their load as if you weren’t already tied down with your own overwhelming load. They would expect you to do all their scut work, help with scribing their discharge summaries and anything they needed you to do while you also tried to focus on your own patient load, rounding, completing your own discharges and summaries, along with progress notes while also delivering actual patient care and managing their acute or chronic conditions as to get them better,  calling families on your own patients, and doing an overwhelming amount of admissions after rounding which the doctors would just sign off on as the collaborating physician.

I find that in these collaborative settings, it obviously benefits the doctors and organizations the most, they pay you minimally, overwork you, don’t support you the way in which the State restrictions claim you need, you are already practicing and making decisions on your own, you are taking large patient loads with lots of distractions and responsibilities from day 1; so is the claim that experienced mid-levels aren’t safe?



So, the question remains, why restrict NPs from full practice authority once experienced? It is preventing mid-levels from being able to provide themselves with better quality of life. There is a chance at significantly increasing salary from having your own practice, and also the ability to contribute to the increased access and care of patients. It has been found that NP full scope of practice improves access and quality of care and leads to better patient outcomes. It also has the potential to reduce health care cost.



Unfortunately, current NP schools clinical training needs to be revamped for better clinical training and experiences; so until then, upon graduating there will need to be some guidance, so revise laws sooner than later to offer NP full scope of practice after 2-3 years of working with a collaborative physician.



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