The MS Board of Nursing and the Board of Medical Licensure have long had a fairly contentious relationship when it comes to Nurse Practitioners and their scope of practice. Let me just say up front that, although I may be in the minority, I am not one of those NPs who want independent practice. I think collaboration with a physician is not only necessary but beneficial for the NPs, the MDs and the public. The lengths that the BOM will go to to try and oversee that is where I typically disagree.
Within the past few months the BOM has made proposals to their regulations for physicians that could ultimately impact NP practice in a negative way. I won't go into the details that would probably be fairly boring to most people, but suffice it to say that Dr. Ross has also agreed that some of the proposed restrictions would be detrimental to our ability to provide patient care in the current manner in which we are doing. In light of that, he attended the hearing at the BOM related to the changes to voice his concern. I invited myself along since it could also affect me. I also offered to begin the applause when he finished talking but he declined. Party pooper.
The room where the hearing was held was packed. Mostly with NPs. We got there early and still had to stand. The first two people on the list to speak were hard for me to follow. To the point that I thought I was in the wrong place. Then I realized they were lawyers. No wonder.
Several NPs and hospital administrators talked about how the proposed changes would negatively impact their ability to provide care in rural areas. I was most impressed with some of the MDs who spoke up. Dr. Ross, of course. But there was also an OB-GYN from Jackson and an internist from Forest General who is over the Hattiesburg Clinics. Both of them were clear, concise, and well spoken. And I am sure that the fella from Hattiesburg Clinic would have a major problem on his hands if the NPs over there are restricted in any way.
There were also a couple of physicians that spoke who were clearly pawns of the medical board. Then came the medical student. Bless his heart. He was there with some of his med school cohorts. They had on their little white coats. He started off by talking about how much collaboration between MDs and NPs is needed. It went downhill when he started to spout these anecdotal negative stories about NPs that he had heard from a rural family practice doctor.
First of all, let me say that I will be the first to admit that NPs make mistakes. And so do physicians. Which I think the boy forgot. Or just doesn't know. I have noticed all through my nursing career that if a doctor makes a mistake, its just human nature. An accident. If an NP makes the same mistake, its because she is a nurse. Not a doctor. Let me tell you that is a hard thing to face day in and day out. I'm not whining, but just explaining the nature of the beast.
The examples of "mistakes" he used in his talk were very vague. Along the lines of "misdiagnosis" as he put it. At the beginning of my career as an NP, I learned much of what I know from Dr. Jim Roberts. Two things have really stuck with me:
1) Crazy people get sick too. That is a post unto itself, but it is true. And that is why I always try and really listen to what a patient is telling me. I may have seen them twice a week for the past six months with piddly stuff, but this could be the time they are really sick.
2) There is almost always more than one right answer. That is the one that applies here. And I think it is the one that medical student hasn't learned yet. And, sadder still, one that that family practice doctor that he talked to still hasn't learned.
I left while he was talking. I had all I could stand. And I could tell my fellow NPs were getting roused up. Jeff left just before I did, so I had to call and tell him what the boy was saying that made me so angry. He said,"I'm sure there are NPs like that, but fortunately I have never met one." That's the kind of boss I have, folks. And we also talked about how the same applies to physicians. I have worked with a couple that were so atrocious that I didn't want them on my protocol because I didn't want to be associated with them. I also remember really early in my career as a hospitalist determining a lady in her 80's had a dissecting aortic aneurysm rather than the gallbladder problem the physician had diagnosed her with an hour earlier. That is something someone half her age would struggle to survive, but she made it. Because of me. In spite of that physician's misdiagnosis. And I don't think any less of that physician. He is excellent. The point is, we are all human. We are going to make mistakes. But we have to do the best we can to provide the best, most appropriate, compassionate care that we can. And that is why I go to work every day.
And this is why I come home.....
This is what my kids were doing after we had dinner. That's the good stuff right there.
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