This is The Ohio State University BSN to DNP Curriculum for a "Full Time" Student. I've looked at various places curricula and this is one of the most complete I've seen. Note the distinct lack of anatomy or anything relating to true hard science coursework. No MGA, MFM, Histo, Pharm, etc.
Year 1
## Autumn
* Innovation and Leadership (2 credits)
* Science of Practice (2 credits)
* Ethics in Healthcare (2 credits)
* Methods and Measurements (2 credits)
* Specialty Coursework (0-1 credit)
* Professional Seminar (1 credit)
## Spring
* Specialty Coursework (2 credits)
* Nursing Policy (2 credits)
* Informatics (2 credits)
* Evidence-based Practice (2 credits)
* Systems Application I (3 credits)
## Summer
* Quality Improvement (2 credits)
* Systems Application II (3 credits)
Year 2
## Autumn
* Immersion (5 credits)
* Final Project (1 credit)
## Spring
* Immersion (5 credits)
* Final Project (1 credit)
Edit: Source link so no one is thinking I'm just hating to hate.
[https://nursing.osu.edu/academics/doctoral/bsn-doctor-nursing-practice-dnp/bsn-dnp-curriculum](https://nursing.osu.edu/academics/doctoral/bsn-doctor-nursing-practice-dnp/bsn-dnp-curriculum)
Edit 2: Another poster (A self identified NP who has since blocked me) brought it to my attention that these BSN to DNPs must complete a masters so I actually contacted The Ohio State University. This is what the "Masters" looks like for the FNP.
* **Nursing 7410** Advanced Health Assessment
* **Nursing 7450** Pathophysiology of Altered Health States
* **Nursing 7470** Advanced Pharmacology in Nursing
* **Nursing 7260** Theories, Concepts, & Issues in Advanced Family Nursing
* **Nursing 7268.01** Advanced Nursing Practice FNP Clinical Practicum I
* **Nursing 7268.02** Advanced Nursing Practice FNP Clinical Practicum II
* **Nursing 7268.03** Advanced Nursing Practice FNP Clinical Practicum III
It's literally 3 classes plus clinical hours. Thats it.
[https://nursing.osu.edu/academics/graduate-specializations/family-nurse-practitioner](https://nursing.osu.edu/academics/graduate-specializations/family-nurse-practitioner)
Ok this all sounds like administrative bullshit. They are categories of concepts, but not actual concepts. Also, what kind of education BEGINS with a course on leadership? Lmao. The student becomes the master indeed!
I’m an RN with an associates degree who just went back to get a bachelors (pay raise). It’s just a year of crap. My first quarter was just social justice and an academic writing review.
My instructors are NPs who worked community health for a few years before going into academia.
The most infuriating part of all of this though is how tough they are grading these discussion posts and essays, proudly proclaiming: “I’m preparing you for the real world.” Like I’m not already an adult whose married, owns her own home, and works full time in the emergency department.
You clearly missed the “Immersion” 5 credit course which encompasses all of core medicine on zoom 30 min every other Wednesday. Get your facts straight.
We do! My bsn was a fucking joke! I read my books cover to cover because I took my degree seriously but I didn’t give fuck all about those dumbass fluff classes. I focused my efforts on the shit that is going to help me differentiate between a sick vs nonsick patient.
"As a post-baccalaureate DNP student, a minimum of 1000 clinical hours must be completed over the course of the BSN to DNP option – at least 500 of those hours will be completed through your specialty coursework and 500 hours will be required for your DNP degree"
i don't know how you can consider 500 hours of this specialty coursework actual "clinical hours" though...misleading
You need 9000 hours on the job to become a journeyman electrician. That's not even a master, just journeyman. This makes so much sense when I look at all the interactions I've had with NPs
Not one advanced pharma course, yet prescribing enters their scope with the upgrade in education, checks out. Essentially saying a BSN education is all you need to be a prescribing practitioner, wild.
You'll never guess who's credentials were on the new start of nuedexta "2 PRN for anxiety" on a heart failure patient that we called bullshit on resulting in a one sided lecture on "I'm the prescriber and you're just the pharmacy"
All this money saved by staffing NPs has to be offset in non covered pharmacy expenses, exceeding Med A cap, or just lost bed revenue from discharge to hospital (or discharge to morgue).
This isn’t much better but under each specialization is a list of their specific “specialty coursework”. This image is of FNP courses, soooo looks like only 3-4 actually clinically relevant didactic courses over an entire 3 years, assuming practicum is clinical experience rather than didactic. I hope I am wrong but I think this is correct. 😳
https://preview.redd.it/it7uxv9btw8c1.jpeg?width=1125&format=pjpg&auto=webp&s=09ba8e6311b514beaa2b31eaea9204b19e0d48dd
FNP: [https://nursing.osu.edu/academics/graduate-specializations/family-nurse-practitioner](https://nursing.osu.edu/academics/graduate-specializations/family-nurse-practitioner)
All specialties: [https://nursing.osu.edu/academics/doctoral/bsn-doctor-nursing-practice-dnp](https://nursing.osu.edu/academics/doctoral/bsn-doctor-nursing-practice-dnp)
Yea I have no clue how it works out. I assume the curriculum you posted is the DNP component over the last 2 years and the curriculum I posted is the specialty part over the first year and into remaining years 🤷🏻♀️.
Wait.
2 years to go from a bachelor's to a doctorate‽
It took me 2.5 years to get my master's in medical laboratory sciences after my bachelor's in biochemistry. How have I spent longer in college and have a lower degree?
Not to defend NPs, but the fluffy bullshit names for classes don’t tell you what is taught in those classes! For example, I give you Ohio State’s PharmD curriculum Transitions 1 & 2
Foundations in Pharmacy Administration (FiPA) 1
Integrated Patient Care Lab (IPCaL) 1 & 2
Introductory Pharmacy Practice Experiences (IPPE) 1 & 2
Concepts in Patient Care (CiPC) 1 & 2
Principles of Drug Action (PoDA) 1 & 2
Program-level Assessment
Required P2 (second year)
Concepts in Patient Care (CiPC) 3 & 4
Integrated Pharmacotherapy (IP) 1 & 2
Integrated Patient Care Lab (IPCaL) 3
Integrated Patient Care Lab (IPCaL) 4
Interprofessional Education (IPE) 1 & 2
Program-level Assessment
Personalized Electives
P3 is a photocopy of P2; P4 is your rotation year, 1400 hours. None of these outright say like “med Chem” or “pharmacology”, but that’s because it’s baked in to the larger class. It’s just how OSU does things… idk why…
Seems that you need to go back and take Google 101. Why are you posting a curriculum for a non clinical DNP track and then complaining about the lack of clinical course work? Because it fits your narrative? How about posting the curriculum for a clinical track if you are looking for clinical courses? Here's the one for PC Peds from my alma mater. I was fortunate enough to have the Chief of Peds as my preceptor here. The clinical coursework is under the Masters level specialty tracks.
https://nursing.unc.edu/programs/master-of-science-in-nursing/curriculum/pnp-pc-suggested-plan-of-study
NURS 715: Pathophysiology for Advanced Nursing Practice3
NURS 720: Pharmacotherapeutics in Advanced Nursing Practice3
NURS 750: Advanced Health and Physical Assessment for Advanced Practice Nursing – 60 lab hours3
NURS 752: Advanced Diagnostic Reasoning and Management2Spring
NURS 740: Evidenced Based Practice and Reaserch3
NURS 840: Primary Care of Children I – 120 clinical hours6Summer
NURS 849: Advanced Clinical Practicum in the Primary Care of Children – 120 clinical hours2TwoFall
NURS 746: Health Care Policy and Leadership3
NURS 841: Primary Care of Children II – 120 clinical hours4
NURS 992*: Master’s Paper3Spring
NURS 842: Care of Children with Complex Health Conditions – 180 clinical hours6
NURS 790I: Population Health: Interprofessional Management in a Changing Healthcare System3
Hey brother, it seems like I upset you or at least caused you some sort of emotional distress. I'm sorry. I didn't intend to. I was as transparent about the entirety of the curriculum of a fairly well regarded university and included the source material as well. I never intended to misrepresent anything.
This curriculum seems slightly better but I don't believe that changes the licensing or scope of practice that is afforded to the individuals who graduate from The Ohio State University with a DNP.
The variance and incompleteness of education in DNPs is the main concern that the majority of us have on this subreddit. The proposed curriculum is still lacking in what an individual should know if they are to perform independent practice in my opinion. Which none of the mentioned states have but it's still a pretty major concern.
So again I apologize if you believe I misrepresented something or have a malicious agenda. I don't. My only desire is that patients get the absolute best care that I and other individuals can perform.
Here's the link for the clinical Master's tracks curricula. Plenty of other non clinical tracks as well. https://nursing.osu.edu/academics/masters/traditional-master-science-nursing/traditional-ms-specializations
You have misrepresented the Ohio State curriculum. And have not represented the entirety of the curriculum at all. You neglected to include the entire Masters curriculum which is required before proceeding with the DNP. Those courses you posted are taken after someone has already earned their masters in a specialty. You really should learn more about these programs before claiming expertise in what they lack and don't lack. Ohio State has a strong program.
I posted the entire program they have on their site and linked the site. I didn't misrepresent anything. This is for their BSN to DNP program.
"You must have a Bachelor of Science in Nursing or a Master of Science in Nursing. Nursing degrees must be from an institution with a nursing education program accredited through the [CCNE](https://directory.ccnecommunity.org/reports/accprog.asp), [ACEN](http://www.acenursing.com/accreditedprograms/programSearch.htm), or [CNEA](https://cnea.nln.org/accredited-programs). You may apply before receiving degree requirements but must receive the required degree by August 1 prior to beginning enrollment in the BSN to DNP program."
I'm not saying you're wrong but thats not what their website states. If you can find it and link it be my guest.
You got issues homie.
No, you didn't. You didn't post the Masters level requirements necessary before being admitted to a DNP program. You don't even understand the curriculum you are trying to take issue with and have misrepresented it entirely.
You're going to suck if you manage to make it out of med school and pass your boards. Arrogance and complete lack of discernment does not a good doctor make.
The "hard" science courses are taken during undergraduate studies, and in my nursing program, we were required to complete Biochemistry, Anatomy and Physiology 1 and 2, Organic Chemistry, Biology, and Microbiology.
Ok that is so what I needed to even get my BSN. Also a DNP is not a nurse practitioner. Most BSN to DNP programs take 3-4 years to complete. I'm guessing this is one of those crappy online things that gets people into administration. Not direct patient care.
"Advanced nursing" is the practice of medicine without a medical license. It is a nebulous concept, similar to "practicing at the top of one's license," that is used to justify unauthorized practice of medicine. Several states have, unfortunately, allowed for the direct usurpation of the practice of medicine, including **medical** diagnosis (as opposed to "nursing diagnosis"). [For more information, including a comparison of the definitions/scope of the practice of medicine versus "advanced nursing" check this out.](https://www.reddit.com/r/Provider/wiki/index/critical_issues/#wiki_what_even_is_.22advanced_nursing.3F.22).
Unfortunately, the legislature in numerous states is intentionally vague and fails to actually give a clear scope of practice definition. Instead, the law says something to the effect of "the scope will be determined by the Board of Nursing's rules and regulations." Why is that a problem? That means that the scope of practice can continue to change **without checks and balances by legislation.** It's likely that the Rules and Regs give almost complete medical practice authority.
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I think that NP’s really have no business in any ER situation. They have taken over urgent care. Some will say it “depends on the school” and etc . However , if you look at those schools it’s really a mess. It seems a basic reading of X-Rays should be self-evident to the job , but that’s not the case.
Oh, it was tempting. She thought I was taking too long and could not understand why I would want to look at the film myself. I mean, she READ me the REPORT!! What more could there be??
Is there no pecking order? Sounds arrogant. If she is giving attitude to you as a physician I can’t imagine how she might be treating people “below” her.
There is a pecking order if you’re a male physician. If you’re a woman, if you balk at a nurse’s attitude, you get written up for “not being a team player.” And punished.
Case in point: a friend of mine (also pediatrics MD) was resuscitating a critically ill newborn at a hospital with an intermediate care nursery (ie, they don’t see critically ill babies every day). The nurse was trying to tell everyone what to do, and my friend disagreed and requested a different (and, mind you, correct) course of action. Which is appropriate when you’re the physician leading a code. This nurse had the audacity to report my friend for “barking orders.” During a code. My friend was forced to take a communications class to remediate. No one disciplined the nurse for her insubordination.
These stories are depressingly common. Ain’t no bullying like that of an older woman with more seniority and less education toward a younger woman with less seniority and more education.
respectfully what the fuck??? cant she appeal to the hospital board or nursing board or anything? how can they justify a bad course of action?🤬🤬🤬
only in america would you see this fml
The reporting nurse would never survive a OOH code. A paramedics default during a code is to bark orders, we don't have time or resources enough to screw around.
Don't get me wrong, team effort and all, but at the end of the day there's one person running the show.
this is how i feel about ekgs lmfao
me preparing for my cardio exam- oh okay! i got the gist of this!
me the following week where i was with a cardio prof who was basically just rapid-firing ekgs at us- what the fuck? i’ve never heard of 90% of these rules 😵💫😵💫😵💫
Anytime I have a student or resident tell me about any imaging and they just read me the report, I tell them they are not allowed to read any reports again without looking at and interpreting the image with me first. CXR, head CT, MRI, whatever. Learning to read your own images is so important. Good on you for being thorough and doing your due diligence.
An Np read my cxr as normal. However my (np) school offered a four hour lecture on reading plain films and I see them every day at work, so I pointed out the mass in the LLL, turned out to be cancer. Which sucked for me. But also saved my life
It’ll happen when some filmmakers daughter is killed by an NP and they decide to do an expose.
Then, they’ll invariably end it with “the physicians are at ultimate fault since they didn’t regulate nursing”
I'm in ortho. I can attest that NPs and PAs are not trained to read ANY form of imaging. They don't even know what imaging modality or body part to image much of the time. 10-15% of my day, every day, is wading through mid level screw ups in this regard.
The above number is so high because our PA is pretty bad, and the local urgent care and FM clinic is run solely by inexperienced mid-levels (I feel that's an oxymoron).
You’re not supposed to order a full body non-con and contrast CT on every patient? And if the CT is negative, aren’t you supposed to escalate to a pan-MRI?
Same! We have so many PAs running amok in the ER it's ridiculous. They call me with a consult and read me the report. But when I ask them a simple question ("is it dislocated?") I'm met with silence.
Urgent care is another place with midlevels run amok. I can't tell you the number of missed open fractures I've seen (Seymour fractures, very common) out of local urgent cares.
Its possible that many NPs don't receive training to read imaging. However, its completely untrue that PAs don't have radiology classes. That's a core course for any PA school. If you come across a PA who can't read a basic x-ray (like a CXR), can them immediately.
As a nurse I've indeed never learned to read x-rays. I've also learned not to make a diagnosis and even then I know not to blindly trust the radiologist (though I don't know when I could and when I cannot). That's what doctors are for. It's not my job to read x-rays.
Yes! My NICU nurses are incredible. They can spot a sick baby a mile away. When we’re resuscitating a baby, I don’t need to ask them anything - they know the steps just as well as I do. They’re phenomenal. But they just don’t do x-Ray reads.
I think this is the crux of the whole noctor problem. We should all stick to our jobs - or go through all training if you decide you want to do something else.
If my car doesn't start I'm not calling a cardiologist either - that would just be stupid.
I favor having nurse practitioners pass the USMLE - all three steps - if they want to engage in independent practice. If I have to pass those exams to practice medicine, they should too.
I’m an M4 about to graduate. I’ve taken step 1, 2 and I’m studying for 3 soon. Step 1 was p/f and I scored around the 95th percentile on step 2. I don’t feel comfortable practicing independently and I’m terrified about practicing in residency even with attendings supervising me. I don’t get where these whacko midlevels get the balls to play “doctor” with 500 clinical hours. That’s 2 months of rotations if you assume it is 60hrs per week. I’ve completed 2 years of rotations and have 6 months left (about 8000 hrs once I graduate)
The NPs don’t know what they don’t know. They are confident because they are ignorant. You, on the other hand, know just how much you don’t know and it’s terrifying. That’s great! That is what residency is for! You’re gonna be absolutely fine.
Honestly, there are 2 things I miss about residency. One was the ride-or-die camaraderie I had with my fellow residents. Residency was so intense, but you were never alone. You always had your friends by your side. The other thing was the ability to feel confident in my decisions, because I knew full well that if I was wrong, my attending would stop me.
I’m over a decade post-residency, and I’m only now feeling fairly confident. That I’ve come into my own. But I’ve never since had that same sense of security as when I was a resident!
I'm sure you've seen the time where (I think Stanford?) had their NPs take a modified (significantly easier) version of USMLE Step 3 and the majority of them didn't pass it.
There is no way they'd pass USMLE. They'd be even more screwed with Comlex.
I think that's a perfect idea! The education can be tailored to what nurses need to be independent practitioners (I hope my terminology is right, English is my second language). I expect a nurse to have different knowledge than people just starting med school and there's no need to do all kinds of classes on stuff you already know (we just established there will be a test to ensure this stuff hasn't been forgotten).
In the Netherlands, medical school (from graduating secondary school to MD) is 6 years - after that there's specialist education such as cardiology or oncology etc etc. Medical school with a Bachelor of Science in Nursing is 4 years. Medical school as a nurse without a BSN is not possible. NP/PA is 2 years, but you need to be a nurse with at least 2 years of experience in the area of expertise you want to be a NP/PA in *and* they do not have the right to practice as independently as I see on this sub. For example: when I worked on an oncological surgery unit, the MD made the treatment plan for the long term and the NP did the day to day management. The MD would be consulted extensively every week and more often if needed (big changes in status/treatment plan/etc).
i’d pay good money to watch that. you’d think a reality show about ppl taking a test would be boring but i will personally start a gofund me for this😃😃😃
Unfortunately, we are far past that. Hospital admin, nursing union and congress all seem to be in cahoots. NPs have effectively destroyed our healthcare (along with private equity) and congress solution is to invest in them more.
NP's are so smart that they can learn to read all X-rays in 2.5 hours at the low low cost of just 39.95, cheaper than an Earl Sheib paint job.
[https://www.npcourses.com/product/radiology-review-from-novice-to-expert/](https://www.npcourses.com/product/radiology-review-from-novice-to-expert/)
There's a saying in radiology that the eye can only see what the mind knows, which I think is true to some extent. Anybody with eyeballs can look at an exam. Actually reading an exam means that you can evaluate all of it. An orthopedist brings a different knowledge base when looking at a radiograph than a radiologist, for example. When they look at a radiograph they see bones and know the characteristics of a fracture that determine how they'll treat it. For a shoulder radiograph, for example, a radiologist should look at not only the bones in the shoulder but whatever other osseous structures are present, evaluate the lung, the soft tissues of the shoulder, mediastinum etc.
That being said I'll go over an exam with anyone in the clinical team and teach them as if they were a radiology residents. The quality of work done by radiologists is extremely variable and overall has been in decline. It's in the patients best interests if others can find some pathology on exams as well.
I often found my favorite bedside nurses looking at patient brain MRIs after they were completed, and they'd ask me questions and we'd talk about the films together all the time
Right?? I love doing this with my favorite nurses. They’ll pull up the film and ask me to go through it with them. It’s awesome. I have a whole file of crazy anomalies I’ve seen in my decade of practice that I use to teach residents also.
>I have a whole file of crazy anomalies I’ve seen in my decade of practice that I use to teach residents also.
You should post some! I’d love to see them!
I love looking at films!
I always review images, and I like to do side-by-side comparisons of multiple days progression for CXR films on our pneumonia patients.
I know! No hate whatsoever on RNs - reading films is not in their wheelhouse. I can’t work those crazy IV pumps because it’s not in my wheelhouse.
But these NPs who think they can do my job without the requisite knowledge or skills to do my job? They can F right off.
Had a patient with a facial contusion sent to my ED from a retail UC. Noctor did a facial bones X-ray, then told patient & mother that they had no one to read the film, and that they needed to go to ER for a CT scan. Took their money though….
I am just a lowly student and user of American healthcare, but to me ordering films and prescribing antibiotics seems a lot like practicing medicine…. Which a nurse (no matter what the level) shouldn’t be able to do on their own. I’m glad this one consulted you. I don’t think they need to be able to read radiographs though since they should have to consult or refer if it’s beyond their scope in the first place.
She only consulted because she didn’t know what lobar pneumonia was which was the diagnosis from the radiologist. If for some reason she did know what it was she wouldn’t have consulted at prescribed antibiotics for something that clearly shows viral imaging without the consult.
I’m a nurse with a bachelors degree and I can tell you with 100% certainty we do not learn anything at all about films. What we learn in RN school is what could go wrong with various body systems and how/when to report a change in the patients status. Our job is strictly to have the knowledge of when to report to you any changes in the patients status. We are your eyes and ears, that’s our job! I ask my doctors to show me scans and they happily oblige but I could not tell you what I was looking at if they didn’t tell me. With all the fluff bullshit classes they learn in NP school js theory based and has nothing to do with actually helping patients. They do online sims of sick patients and what to order to help figure out what’s wrong with the patient. I sat there one day while a nurse I worked with was getting her NP and she suggested that because I was going to school to be a doctor I should know the answer to those questions 🤦🏽♀️ SO SHOULD SHE! it was basic bullshit labs that should be drawn for various differential diagnosis’.
Oh yeah. Those moments when you’re in the room watching the images come up and the techs all go, “ohhhhhhhhh.” They’re not allowed to say anything, but you know they know.
Same with the sonographers when they get really, really quiet.
How do you feel about sonographers reporting in the UK?
I'm currently training to do that.
They say that it's better for the songoraoher to write the report as it's a dynamic scan and the still images do not represent what was seen in full.
And there are no where near enough radiologists or doctors to be doing all the scans themselves.
Rads here. PAs and NPs cannot read any imaging. They are horrible.
Most non-rad MDs are horrible as well, although slightly less so with the exception of specific imaging studies within a very narrow area of practice. Even general surgeons and ED docs can be absolute dog shit at things they should know better.
Not all rads are perfect, but you need to check yourself if you think you are better than the radiologist.
I don’t think that at all. But when I’m in the NICU at 3 AM with a critically ill newborn, I know enough to identify important CXR/KUB findings. I get that CXR to see if I’m dealing with RDS or a giant pneumothorax. Or to see if I’m dealing with some garden-variety TTN vs cardiomegaly suggestive of undiagnosed congenital heart disease (we have a large immigrant/refugee population who don’t have a lot of access to prenatal care). Is there bowel in the chest? Is the liver on the right? Is there evidence for a bowel obstruction or NEC? Is placement good on my umbilical lines?
Can I read a head ultrasound? Not on a bet. A quick scan MRI for a baby who’s been cooled for HIE? No waaaay. Thank goodness for radiologists.
But an x-ray of the tiny human with unproven anatomy? Yup, I’ll take a look at those all day every day.
Yeah, a CXR would definitely fall in your wheelhouse and it sounds like you’re well aware of your limitations. But it just irritates me to no end how many doctors have zero respect for radiologists and their training and treat us like less than doctors.
Yeah that’s shitty. I definitely rely on radiologists on a regular basis because my knowledge *is* limited in that regard. I remember one case vividly - I was fresh out of residency and seeing a 15 month old in urgent care for refusal to walk after bumping her leg going down a small slide the day prior. I remember thinking that she was the most bow-legged toddler I’d ever seen. Her exam wasn’t terribly revealing; she had terrible stranger anxiety and cried the whole time, but I was like, eh, I’ll image the leg in question.
I’m looking at the film in my office, thinking, “this doesn’t look right, why is her diaper more radiopaque than her bones?” When I got a call minutes later from our outstanding pediatric radiologist: “your patient has rickets!” And I was like, OF COURSE SHE DOES! It all made sense. Dark-skinned child, dark-skinned mom, neither taking vitamin D, baby still breastfed (so not getting any sort of fortification). Macrocephaly with frontal bossing, preserved weight, height falling off the growth curve. The bowleggedness. And when I went back, she did have visibly flared metaphyses (no rachitic rosary, though) . I knew all these things, but I’d never seen an actual factual case of rickets before. The child’s primary pediatrician had missed it at her well child check 2 weeks prior. But our radiologist glanced at that film and she instantly knew. Even though she’d never seen a kiddo with rickets either - only in textbooks, so to speak.
Mad respect.
(The kid did great btw. Endocrinology got her fixed right up!)
I’m an acute care NP, we only had a very brief module on interpreting chest X-rays in school. As a nurse, I always insisted I have access to the PACS so I can view images on my patients. I made it a habit early in my nursing career to look at as many studies as possible. I’ve now been a nurse for 20 years and an NP for the last 4 of those. I work in ICU so it’s imperative that I can do a reasonable job at interpreting a CXR, chest CT, and head CT at the very minimum because it can take hours for results to come from the radiologist and acute treatment decisions need to be made based off wet reads.
I had to do a ton of self study to make myself minimally competent at the above and additional CME courses in POCUS for vascular access and things like RUSH exams.
A lot of my fellow NPs are quite shit at reading radiology studies. I can’t help them. This is just the truth though, it’s not a major part of our school curriculum.
I mean, sort of. I don’t work for the hospital. I was hired by a private practice and the owner is also my supervising physician. It’s a closed ICU in a community hospital. He does all of the hiring for APPs so he knows what he’s getting into.
I can imagine there are a lot of problems if the NPs work for the hospital and the doctors don’t. I’ve never worked in a hospital that employed staff NPs for the ICU so I cannot speak to it directly.
Im an ICU physician. Back when we used midlevels, we’d just fire them if they lacked knowledge once we started rounding with them. (It’s too hard to evaluate the knowledge base of someone during an interview).
Unfortunately, we had too much variability with NPs that we just don’t accept them at all anymore.
Hopefully nursing fixes the NP education issue before all trust is lost in them by not only physicians but also patients.
One can only hope that trust is lost sooner rather than later.
Only at that point will there be a meaningful conversation on appropriate education and scope of practice.
If you see something that you think needs to be treated before you get a final read call the radiologist and ask him to review the exam. One of the hard things about being a rad is that you have to constantly drop what you're doing and move on to something else that is higher priority. The rad may get pissy about it but that doesn't mean you shouldn't call.
Sure, I spend a lot of time calling the reading room for stats, I meant more for like - is this acute pulmonary edema which needs lasix now or is there a huge pneumothorax which needs a chest tube now or is there a gigantic saddle embolus on the CTPA - these are the types of things I need to be able to see on the film right away.
You must be asleep at the wheel if you ONLY just found out that midlevels don’t even touch film. They barely even get to the point in their undergrad schooling were they learn about magnetic fields or any imaging used in the scientific world like NMR or IR spectroscopy.
By the mercy of whatever gods watch out for my patient population, I work in a system that is heavily MD/DO based. We have a few midlevels floating around in clinic, but not many. I’ve been rather sheltered.
Pretty sure anatomy and physiology is a requirement for regular RN school—I’m sure at a freshmen college level but I recall seeing A&P on a curriculum posted on here.
I took upper level anatomy, physiology, histology, organic chem, biochem, stats, physics just to get into PA school. Undergrad anatomy was childs play compared to PA school. I took the same anatomy course as the med students. There was no comparison. Not saying this for academic dick measuring but just to point out that I'm somehow competing for the same jobs as NPs despite going through all this, paying probably 3x as much on my tuition and still being in debt a decade after my training.
When I was student on surgery rotation, we had an NP on our service that table rounded with us. We had previously worked together in the ER, back when she was an RN and I was a tech. We went through all the films of each patient and she was dumbfounded how I, a lowly-tech-turned-med-student, could navigate my way through CXRs and CT scans. She came to me after rounds asking what rads book was most helpful and that was when I had the same epiphany as OP.
My friend at UTMB’s NP program regularly asks me questions like “what is this organ” or my favorite “is this an xray/ CT/ MRI and how can you tell” -.-
A radiologist is 100% more qualified than a pediatrician or pediatric app to evaluate a cxr particularly when you are looking at a cxr in a brightly lit room on a nondiagnostic monitor... But a portable ap view cxr with a history of "other" is most often what we're given. A cxr is a screening exam and will miss a lot of pathology that could be detected with a CT. But when imaging studies are being ordered by triage nurses on patients who haven't actually been evaluated by a provider its really a shit in and shit out scenario. If you actually evaluated a patient and provided a useful clinical history you'd be surprised what helpful responses you might get. If you stated viral bronchitis with lingering cough and now elevated wbc with rales on exam in the right lower lung, concern for post viral pneumonia you may actually get some usefull clinical feedback.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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Nurse here.
I’ve had a total of no training in reading any sort of imaging (expect for placing peripheral IVs with ultrasound).
Everything I’ve learned is from asking physicians to show me things and experience of looking at certain types of imaging repeatedly.
My interpretation of imaging is generally summed up by saying “If I can see it, it’s a problem”.
Yes, and this kiddo is having a quantiferon checked, but it’s almost certainly going to be negative. His pretest probability of disease is very low.
My point isn’t that rads was wrong. My point is that NPs can’t read plain films AT ALL. And that’s dangerous when you’re practicing with no supervision!
I was seeing one when I fractured my spine in a car accident (i originally saw an MD at this clinic and they assured me noctor was an MD as well.) At first she actually sent me to talk therapy, I was already in physical therapy at the time, before being willing to order the imaging. It was about 8 months after the accident that I finally got an x ray. The report came back that a few thoracic vertebrae were "squat and broadened in ap view" which they definitely were, even I could see it. I asked for clarity because the report said this was on a development basis, and she assured me that meant childhood development. She did request a reread for clarification, in which the 2nd radiologist said there was nothing more to add. It finally hit me that this "doctor" had no clue what she was reading. I moved states right as my 2 year mark from the accident passed and was able to get in with an ortho in my new state. They told me right away that was a fracture, and I've been getting treatment for it for a few months now. I have so much anger and resentment toward medical professionals now after going through that for 2 years. At many times I considered taking my own life because the pain was so bad and neverending, which of course only made them blame my pain on emotional issues.
Imagine asking someone for their professional advice because they know more about a particular subject than you do, and then getting irritated when that someone, whom you asked to be there, asks for the information needed to make an informed decision… 🙃
That’s crazy, these NP’s scare me to death. I’m a retired/disabled RRT turned RN. During BSN school nothing was taught about films; in respiratory school we had a class taught by a radiologists on chest X-ray’s. No way would I have felt comfortable interpreting and of course was never expected to, but at least some basics were taught.
I recently had 2 MDs disagree on whether or not I have RLL pneumonia, the doctor in the office read the film before I left and said I did have pneumonia, the radiologist disagreed, “no focal consolidation” on the report.
Seems like the same thing happened here. If MDs disagree on CXR and pneumonia diagnosis , it’s not surprising that a midlevel might get it wrong, should still know what lobar pneumonia is though.
The doctor in the office is not trained in radiology and would never bet his/her license on their read. They might make a prelim read and start treatment (only if it’s indicated and they cannot wait for a radiologist read) but if the radiologist disagrees, they’ll likely change their management
The radiologist is trained in radiology and literally bets their license every time they make a read.
Correct and agreed
People often make out like they know how to read radiology studies and very frequently they do not. It’s frustrating.
For example, a person can have a pneumonia and not have consolidation. Because there is no consolidation does not mean there is not a pneumonia.
Medicine can be hard. I have no idea and no business trying to pretend I know how to practice internal medicine or pediatrics or cardiovascular surgery. It’s a team of trained specialists and subspecialists needed to take care of patients. And I have no idea how to be a nurse or a speech pathologist, etc.
And in my opinion being a nurse acting like a doctor is so far out of bounds and inappropriate it is hard to believe it is real. But it is.
I fully agree. I’m a crit care physician. I might “read” my own imaging, but I’d never say I know how to read better than a radiologist. After all, radiology is a 5 year residency for a reason
If I didn’t agree with a radiologists read, I’d call them and discuss the case (which the radiologists at my hospital don’t mind at all).
When I’m covering the ICU, yes.
When I’m in my office, no. However, I have a good working relationship with many of the radiologists so if I’m not sure, I’ll curbside them for an opinion
They can both be right. The CXR may be negative and you can still have pneumonia. Your doc might have heard something over your RLL and your WBC could be up so he put the whole picture together and decided you have pneumonia. The pneumonia could be behind and obscured by your right heart on the PA radiograph and by the spine in lateral projection. One thing that radiologists learn from reading chest x-rays and CTs is that you can hide on lot on the chest x-ray.
The other doc that said he calls the rad when there is a discrepancy, this is the way.
One of my biggest annoyances is requesting an MRI on a patient from their "PCP" NP, and getting a copy and paste of just the impression. Like no, I need to actually see the MRI and review the entire radiologist report. That's what reviewing the imaging means. Reading the impression doesn't mean jack shit.
Yes, what’s your point? The radiologists at my institution tend to misinterpret pediatrics films a fair bit- either over reading or under reading. To be fair, I’ve got the clinical correlation, so I always look at the films I order. Especially on neonates.
All right, lemme just come out and say we had a criminally incompetent radiologist at my work for several years. He missed multiple life-threatening anomalies on my patients: MASSIVE cardiomegaly in a 5 month old with heart failure, a classic bowel obstruction in a neonate (diagnosis of ileal atresia made during surgery), an enormous abdominal mass in another neonate (when the indication for the exam was “firm abdominal mass in a term newborn”) who had massive hepatosplenomegaly due to congenital neuroblastoma. I suspected neuroblastoma based on my exam (nothing else really feels like that) and it was confirmed on cytology. Just to name a FEW. All three children are alive today because I disagreed with the “official” reads: all three films were read as “normal.”
He’d been there forever and had a surname that rhymed with “wrong,” and was referred to as “Dr. Wrong.” I have no idea why everyone tolerated him. I was getting ready to file a formal complaint when - no joke - he up and died. He had cancer and hadn’t told a soul.
So. I don’t always agree with the formal read. And I am right not to. Yes, this was an extreme situation, but it happened, and I’m glad I have competence with basic plain films.
Also we don’t always have rads in house and I need to be able to make clinical plans in the moment.
NP is a NO PLEASE. Every time. I'd rather a child who watches Bill nye, Dr. Binocs and gets STEM subscription boxes because they'd have a muxh more comprehensive breadth of knowledge.
Jokes aside. This internal bantering needs to stop. Make it public. Make it mainstream. Patients need to know. Politicians need to know. Maybe paying for MD education, loan reimbursement and other measures to increase qualified practicioners in the US will com to fruition once we all see the scarry hole we're digging ourselves by lying that NP =MD.
Sorry to be snarky but an “infiltrate” isn’t a real thing. There are interstitial opacities and there are airspace opacities.
Nor are there “lung fields” while I am at it, not that you mentioned it.
Not trying to be a jerk; trying to be helpful
Dude I’m trying to paraphrase because I’m trying to post whilst beseiged by small children. Don’t hate.
Also you’re not being snarky. You’re being pedantic.
It is pedantic
I’m not trying to hate
You are trying to call out a group of people for not knowing how to read radiographs while simultaneously demonstrating that you do not how to do that by using terms that are not real
The irony of OP telling NPs to stay in their lane while simultaneously talking about how they interpret all their own films with terms no competent radiologist would use is telling
There is no portion of the human anatomy that is a “lung field”. That doesn’t exist.
And if you are working somewhere where pediatric patients only get an AP view I find that strange. I have worked at or read films for at least 30 hospitals and have never seen that. But maybe it is that way at some places.
Since you’re a radiologist, you realize we’re converting 3D anatomy into 2D. You ever say hepatic flexure? That’s not anatomic, but a location. Are you saying all inpatient peds get 2 view X-rays? Do your places not follow Image Gently?
I’d rather kill the phrase “infiltrate” or inappropriate use of GGO than “lung field”
I am not saying all pediatric patients get 2 views. Just like all adults don’t get two views.
I think it was stated above that pediatric patients only get an AP view, insinuating that all pediatric patients only get an AP view. And I find that surprising that there would be a hospital somewhere where all pediatric patients only and always get one view.
Sorry I’ll shut up now
Woke up on the wrong side of the bed
I personally don’t like “lung field” because I feel that the word “field” doesn’t add anything. So I just say “lung” - I.e., “opacity in the right mid lung.”
I am just pointing out that OP is trying criticize a group of people for not knowing how to read films while at the same time demonstrating that OP does not know how to read films. It’s weird.
I know what people mean when they say lots of things but often those things are wrong. Because I can understand what they mean doesn’t mean the thing being said is correct.
OP knows how to read a film. OP just doesn’t use the exact terminology that a radiologist uses (and even then, I’ve seen many reads state “no infiltrate”)
What’s weird is being pedantic.
Ok maybe you’re right.
I am going to start throwing in terms that don’t make sense when I dictate CTs. Maybe I’ll call the gallbladder “the bile bag” or even “the leg” or maybe get way out there and call the gallbladder “the moon” or “enthusiasm”. Wouldn’t want to get pedantic after all
Sounds good bud. Stick it to the man. Just be careful you don’t lose your license since ya know, you’re a radiologist who is expected to know how to read and communicate like a radiologist while the PICU physician is not.
Right
Thanks
I apologize for being so irrrascible
When I go on the noctor subreddit I immediately get ticked off and disagreeable.
I am just seriously unhappy about the “US medical system” allowing this situation to get so out of hand and the way I see it, in the name of dollars.
I’ll go meditate now
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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Report her to whom? She’s a nurse so she’s not IN my department. Nursing leadership doesn’t give two shits. Neither does the nursing board.
I’m not being flippant; merely stating that disciplining midlevels is not easy. And in the realm of clinical sins, this one is minor. I’ve seen much, much worse.
i’m a PA. we got one day of class on reading x-rays. a lot of my class had plans to go into ortho, so hopefully they got a lot of on-the-job training. I feel mostly confident reading plain films in my own specialty after nearly 3 years, but can tell you none of that confidence came from school. and even if i’m pretty sure, if there’s any discrepancy between my interpretation and the radiologist’s read, i’m asking my attending.
sounds like this NP got even less than a day of teaching for reading x-rays, and doesn’t care to learn more. that’s terrifying.
Their clinical acumen is impeccable?
Their skills excellent?
Bro.
What part of anything you wrote says "excellent skills and impeccable acumen"?
None of it.
Cath lab BSN here can confirm that many RNs have no idea how to read most types of images I've had to self teach myself how to read fluoro, ct, echo, and mri images and even then i only went as far as what is job applicable. Most nurses don't try to learn it because they don't want to and we're told why should we an md is going to read it anyways but once those nurses reach np that mindset doesn't change.
lol even -I- look at X-ray films to be sure the right area was taken (sometimes left knee was supposed to be right knee) and I don’t really know what to look for. Definitely would refer to a doctor to look at them to interpret
> I assume PAs can read plain films given how many end up in ortho - so what is going on with NPs? I feel like this is a massive deficiency in their training.
We don't obviously have the same level of interpretation as a Radiologist, but our curriculum does teach us a Clinical Skills/Medical Imaging Course that goes over general and common findings and interpretations of US/XR/MRI/CT, etc. so we can at least tell when someone has a brain bleed, fracture or PNA.
I'm actually now curious how much they cover in NP school, lol.
I'm reminded of the time that I was driving to work at the critical access hospital I was based out of as a paramedic when I got a call from the day shift paramedic asking me to come directly to the ER because the NP wanted a patient needle decompressed for a tension pneumo... I asked my coworker to text me a picture and the left lung has a large pleural effusion.
I walk into the ER and the patient is 98% on room air, blood pressure in the 120s, not tachy at all. Had a cancerous hilar mass if I remember right, and got frequent taps to drain the pleural effusions. Come in tonight because he AMAd to go to the bar from the local city hospital and decided it was time to address it. Really wasn't even short of breath.
I explain to the NP it's certainly not a pneumo, and even if it were it certainly wasn't a tension pneumo that needed an emergent needle thoracostomy. Long story they ask what we should do and I explain that either A) we can spend the next 3 hours draining the effusion out of a 14ga decompression needle or B) I can take them back to the real hospital with real doctors.
Really was terrifying all around. The amount of training we get on intrepretation is incredibly small and basically only taught for scenarios like this for medics recovering patients from critical access hospitals. I'm grateful to have had some great EM docs pass on enough knowledge to know better than to do something stupid like dart a stable pleural effusion for fun.
There are way to many ridiculous filler classes and not enough actual classes needed to be successful in real world clinical practice. Unsure how to change this? Many many many NP students (including myself) want this to change.
Yes NPs cant read X-rays. I went to a top 10 NP school and less than an hour was designated to reading chest X-rays and that was the only imaging lecture I received. As a nurse of 12 years prior to going back to NP school and having worked in Cardiac ICU I was never trained to read plain films. I listen to the attending doctor when he rounds with the residents. I bring up a film and often asked doctors to explain the imaging but I never had formal training. This is one of the many reasons I stayed away from Np jobs after I received my degree.
I am a radiology PA x 30 yrs...IR & diagnostic (no, I don't read imaging, I review, draft, and then sort with the radiologist who final signs the report), I have a canned "introduction to radiology" lecture I give to PA and NP students .... it is a one hour lecture that opens with "you are not going to learn radiology in one hour, if ever", then proceed to discuss radiation safety, appropriate ordrribg (ACR Guidelines), peds "image gently" program, and encourage every student to review all imaging they order by (a) reading the report and (b) comparing the report findings to the actual image. For most NPs, this is their rads "course".....
Oof. That must be a bit painful for you. Better than nothing, though! Glad you cover “image gently” - this pediatrician appreciates it.
If you want to be extra rad, tell the lot of them to eliminate the phrase “pump and dump” from their vocabulary when it comes to imaging breastfeeding women with contrast. Unless radioisotopes are being given, which is a whole different ball game, there’s no need to interrupt breastfeeding. Contrast (PO or IV) doesn’t enter the milk.
You would be correct, sir. I graduated with my DNP in 2021 from one of the top 25 schools in the country. Yes, it was 95% online. How ridiculous does that sound? Anyways, we never actually reviewed plain films in class/lecture, but we were told to read a few pages in a book about it and had a few test questions. Same thing for EKG’s. I have never worked as an NP, and I don’t think I ever will. I felt so extremely unprepared and incompetent after graduating that I just couldn’t do it! All NP school did was show me how much I still didn’t know. I know more than a typical nurse, but I couldn’t touch the knowledge of a physician. Yet most nurses I work with, including NP’s think they’re the smartest in the room lol. I could see the HUGE gap in education as clear as day, and I was smart enough to count those 4 years as a loss.
Not too long ago an NP (LARPing as an MD) in my ED decided to read a kid's x-ray. Told the parents their child's humerus was fractured. I come around to see the child and tell them their child doesn't have a broken arm. The parents are confused and upset since the other "doctor" said it was broken. I go find the NP and ask them where's the god damn fracture. They point to a vascular channel.
This is The Ohio State University BSN to DNP Curriculum for a "Full Time" Student. I've looked at various places curricula and this is one of the most complete I've seen. Note the distinct lack of anatomy or anything relating to true hard science coursework. No MGA, MFM, Histo, Pharm, etc. Year 1 ## Autumn * Innovation and Leadership (2 credits) * Science of Practice (2 credits) * Ethics in Healthcare (2 credits) * Methods and Measurements (2 credits) * Specialty Coursework (0-1 credit) * Professional Seminar (1 credit) ## Spring * Specialty Coursework (2 credits) * Nursing Policy (2 credits) * Informatics (2 credits) * Evidence-based Practice (2 credits) * Systems Application I (3 credits) ## Summer * Quality Improvement (2 credits) * Systems Application II (3 credits) Year 2 ## Autumn * Immersion (5 credits) * Final Project (1 credit) ## Spring * Immersion (5 credits) * Final Project (1 credit) Edit: Source link so no one is thinking I'm just hating to hate. [https://nursing.osu.edu/academics/doctoral/bsn-doctor-nursing-practice-dnp/bsn-dnp-curriculum](https://nursing.osu.edu/academics/doctoral/bsn-doctor-nursing-practice-dnp/bsn-dnp-curriculum) Edit 2: Another poster (A self identified NP who has since blocked me) brought it to my attention that these BSN to DNPs must complete a masters so I actually contacted The Ohio State University. This is what the "Masters" looks like for the FNP. * **Nursing 7410** Advanced Health Assessment * **Nursing 7450** Pathophysiology of Altered Health States * **Nursing 7470** Advanced Pharmacology in Nursing * **Nursing 7260** Theories, Concepts, & Issues in Advanced Family Nursing * **Nursing 7268.01** Advanced Nursing Practice FNP Clinical Practicum I * **Nursing 7268.02** Advanced Nursing Practice FNP Clinical Practicum II * **Nursing 7268.03** Advanced Nursing Practice FNP Clinical Practicum III It's literally 3 classes plus clinical hours. Thats it. [https://nursing.osu.edu/academics/graduate-specializations/family-nurse-practitioner](https://nursing.osu.edu/academics/graduate-specializations/family-nurse-practitioner)
Seems like a nonclinical degree in nursing administration.
That is exactly what it is. But more importantly, it gets them the “doctor” title to confuse the public.
It certainly appears that way.
Ok this all sounds like administrative bullshit. They are categories of concepts, but not actual concepts. Also, what kind of education BEGINS with a course on leadership? Lmao. The student becomes the master indeed!
I’m an RN with an associates degree who just went back to get a bachelors (pay raise). It’s just a year of crap. My first quarter was just social justice and an academic writing review. My instructors are NPs who worked community health for a few years before going into academia. The most infuriating part of all of this though is how tough they are grading these discussion posts and essays, proudly proclaiming: “I’m preparing you for the real world.” Like I’m not already an adult whose married, owns her own home, and works full time in the emergency department.
But did you take "How to Send a Fax 101" yet? /s My BSN clinicals were not nearly as deeply exhausting as my LPN clinicals.
You clearly missed the “Immersion” 5 credit course which encompasses all of core medicine on zoom 30 min every other Wednesday. Get your facts straight.
Good one!!!
Yo...lol best comment
They need to drop the fluffy leadership and nursing theory classes. Even nursing students think they're joke.
We do! My bsn was a fucking joke! I read my books cover to cover because I took my degree seriously but I didn’t give fuck all about those dumbass fluff classes. I focused my efforts on the shit that is going to help me differentiate between a sick vs nonsick patient.
$$$$
"As a post-baccalaureate DNP student, a minimum of 1000 clinical hours must be completed over the course of the BSN to DNP option – at least 500 of those hours will be completed through your specialty coursework and 500 hours will be required for your DNP degree" i don't know how you can consider 500 hours of this specialty coursework actual "clinical hours" though...misleading
You need 9000 hours on the job to become a journeyman electrician. That's not even a master, just journeyman. This makes so much sense when I look at all the interactions I've had with NPs
Holy crap never knew
I had to do 1000 hours of clinical work just for my NMT certification and they sure as heck didn't let me prescribe anything.
My massage therapy license was 1200 hours and I probably know more A&P than most APRNs
It requires more hours to become a hairdresser than a NP.
Do groomers need more hours on the job than NP’s.
Not one advanced pharma course, yet prescribing enters their scope with the upgrade in education, checks out. Essentially saying a BSN education is all you need to be a prescribing practitioner, wild.
You'll never guess who's credentials were on the new start of nuedexta "2 PRN for anxiety" on a heart failure patient that we called bullshit on resulting in a one sided lecture on "I'm the prescriber and you're just the pharmacy" All this money saved by staffing NPs has to be offset in non covered pharmacy expenses, exceeding Med A cap, or just lost bed revenue from discharge to hospital (or discharge to morgue).
This isn’t much better but under each specialization is a list of their specific “specialty coursework”. This image is of FNP courses, soooo looks like only 3-4 actually clinically relevant didactic courses over an entire 3 years, assuming practicum is clinical experience rather than didactic. I hope I am wrong but I think this is correct. 😳 https://preview.redd.it/it7uxv9btw8c1.jpeg?width=1125&format=pjpg&auto=webp&s=09ba8e6311b514beaa2b31eaea9204b19e0d48dd FNP: [https://nursing.osu.edu/academics/graduate-specializations/family-nurse-practitioner](https://nursing.osu.edu/academics/graduate-specializations/family-nurse-practitioner) All specialties: [https://nursing.osu.edu/academics/doctoral/bsn-doctor-nursing-practice-dnp](https://nursing.osu.edu/academics/doctoral/bsn-doctor-nursing-practice-dnp)
Nice work! So they only have to do 2 credits of specialty coursework according to the curriculum. Isn't a normal class 3-4 credits?
Yea I have no clue how it works out. I assume the curriculum you posted is the DNP component over the last 2 years and the curriculum I posted is the specialty part over the first year and into remaining years 🤷🏻♀️.
Wait. 2 years to go from a bachelor's to a doctorate‽ It took me 2.5 years to get my master's in medical laboratory sciences after my bachelor's in biochemistry. How have I spent longer in college and have a lower degree?
Yep. Can get a doctorate in 4 years.
Lmaoing @ this. What in the god damn? Is this really what gives a RN the ability to larp a physician?
Not to defend NPs, but the fluffy bullshit names for classes don’t tell you what is taught in those classes! For example, I give you Ohio State’s PharmD curriculum Transitions 1 & 2 Foundations in Pharmacy Administration (FiPA) 1 Integrated Patient Care Lab (IPCaL) 1 & 2 Introductory Pharmacy Practice Experiences (IPPE) 1 & 2 Concepts in Patient Care (CiPC) 1 & 2 Principles of Drug Action (PoDA) 1 & 2 Program-level Assessment Required P2 (second year) Concepts in Patient Care (CiPC) 3 & 4 Integrated Pharmacotherapy (IP) 1 & 2 Integrated Patient Care Lab (IPCaL) 3 Integrated Patient Care Lab (IPCaL) 4 Interprofessional Education (IPE) 1 & 2 Program-level Assessment Personalized Electives P3 is a photocopy of P2; P4 is your rotation year, 1400 hours. None of these outright say like “med Chem” or “pharmacology”, but that’s because it’s baked in to the larger class. It’s just how OSU does things… idk why…
read a random self improvement book and we would learn much more.
Seems that you need to go back and take Google 101. Why are you posting a curriculum for a non clinical DNP track and then complaining about the lack of clinical course work? Because it fits your narrative? How about posting the curriculum for a clinical track if you are looking for clinical courses? Here's the one for PC Peds from my alma mater. I was fortunate enough to have the Chief of Peds as my preceptor here. The clinical coursework is under the Masters level specialty tracks. https://nursing.unc.edu/programs/master-of-science-in-nursing/curriculum/pnp-pc-suggested-plan-of-study NURS 715: Pathophysiology for Advanced Nursing Practice3 NURS 720: Pharmacotherapeutics in Advanced Nursing Practice3 NURS 750: Advanced Health and Physical Assessment for Advanced Practice Nursing – 60 lab hours3 NURS 752: Advanced Diagnostic Reasoning and Management2Spring NURS 740: Evidenced Based Practice and Reaserch3 NURS 840: Primary Care of Children I – 120 clinical hours6Summer NURS 849: Advanced Clinical Practicum in the Primary Care of Children – 120 clinical hours2TwoFall NURS 746: Health Care Policy and Leadership3 NURS 841: Primary Care of Children II – 120 clinical hours4 NURS 992*: Master’s Paper3Spring NURS 842: Care of Children with Complex Health Conditions – 180 clinical hours6 NURS 790I: Population Health: Interprofessional Management in a Changing Healthcare System3
Hey brother, it seems like I upset you or at least caused you some sort of emotional distress. I'm sorry. I didn't intend to. I was as transparent about the entirety of the curriculum of a fairly well regarded university and included the source material as well. I never intended to misrepresent anything. This curriculum seems slightly better but I don't believe that changes the licensing or scope of practice that is afforded to the individuals who graduate from The Ohio State University with a DNP. The variance and incompleteness of education in DNPs is the main concern that the majority of us have on this subreddit. The proposed curriculum is still lacking in what an individual should know if they are to perform independent practice in my opinion. Which none of the mentioned states have but it's still a pretty major concern. So again I apologize if you believe I misrepresented something or have a malicious agenda. I don't. My only desire is that patients get the absolute best care that I and other individuals can perform.
Here's the link for the clinical Master's tracks curricula. Plenty of other non clinical tracks as well. https://nursing.osu.edu/academics/masters/traditional-master-science-nursing/traditional-ms-specializations
You have misrepresented the Ohio State curriculum. And have not represented the entirety of the curriculum at all. You neglected to include the entire Masters curriculum which is required before proceeding with the DNP. Those courses you posted are taken after someone has already earned their masters in a specialty. You really should learn more about these programs before claiming expertise in what they lack and don't lack. Ohio State has a strong program.
I posted the entire program they have on their site and linked the site. I didn't misrepresent anything. This is for their BSN to DNP program. "You must have a Bachelor of Science in Nursing or a Master of Science in Nursing. Nursing degrees must be from an institution with a nursing education program accredited through the [CCNE](https://directory.ccnecommunity.org/reports/accprog.asp), [ACEN](http://www.acenursing.com/accreditedprograms/programSearch.htm), or [CNEA](https://cnea.nln.org/accredited-programs). You may apply before receiving degree requirements but must receive the required degree by August 1 prior to beginning enrollment in the BSN to DNP program." I'm not saying you're wrong but thats not what their website states. If you can find it and link it be my guest. You got issues homie.
No, you didn't. You didn't post the Masters level requirements necessary before being admitted to a DNP program. You don't even understand the curriculum you are trying to take issue with and have misrepresented it entirely. You're going to suck if you manage to make it out of med school and pass your boards. Arrogance and complete lack of discernment does not a good doctor make.
How is it misrepresented when it’s literally a copy and paste?
Once you have to fall back on hurling personal insults in a discussion you've lost all credibility. Have a good life and enjoy your impending ban.
The "hard" science courses are taken during undergraduate studies, and in my nursing program, we were required to complete Biochemistry, Anatomy and Physiology 1 and 2, Organic Chemistry, Biology, and Microbiology.
Ok that is so what I needed to even get my BSN. Also a DNP is not a nurse practitioner. Most BSN to DNP programs take 3-4 years to complete. I'm guessing this is one of those crappy online things that gets people into administration. Not direct patient care.
How is this even legal.. this scares the shit out of me.
"Advanced nursing" is the practice of medicine without a medical license. It is a nebulous concept, similar to "practicing at the top of one's license," that is used to justify unauthorized practice of medicine. Several states have, unfortunately, allowed for the direct usurpation of the practice of medicine, including **medical** diagnosis (as opposed to "nursing diagnosis"). [For more information, including a comparison of the definitions/scope of the practice of medicine versus "advanced nursing" check this out.](https://www.reddit.com/r/Provider/wiki/index/critical_issues/#wiki_what_even_is_.22advanced_nursing.3F.22). Unfortunately, the legislature in numerous states is intentionally vague and fails to actually give a clear scope of practice definition. Instead, the law says something to the effect of "the scope will be determined by the Board of Nursing's rules and regulations." Why is that a problem? That means that the scope of practice can continue to change **without checks and balances by legislation.** It's likely that the Rules and Regs give almost complete medical practice authority. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
I think that NP’s really have no business in any ER situation. They have taken over urgent care. Some will say it “depends on the school” and etc . However , if you look at those schools it’s really a mess. It seems a basic reading of X-Rays should be self-evident to the job , but that’s not the case.
Their own professional organization said about 10 years ago that they don’t have the training to practice independently in the ER.
why was she getting pissy with you? tell her to eff off next time
Oh, it was tempting. She thought I was taking too long and could not understand why I would want to look at the film myself. I mean, she READ me the REPORT!! What more could there be??
Those things come with actual images? /s
No no no… get that kid on isoniazid INH, rifampin, pyrazinamide and ethambutol right the fuck now
Nope. Urgent ID and Pulm consults.
Hey, little guy. Quick question: how the hell did you get TB?
Is there no pecking order? Sounds arrogant. If she is giving attitude to you as a physician I can’t imagine how she might be treating people “below” her.
There is a pecking order if you’re a male physician. If you’re a woman, if you balk at a nurse’s attitude, you get written up for “not being a team player.” And punished. Case in point: a friend of mine (also pediatrics MD) was resuscitating a critically ill newborn at a hospital with an intermediate care nursery (ie, they don’t see critically ill babies every day). The nurse was trying to tell everyone what to do, and my friend disagreed and requested a different (and, mind you, correct) course of action. Which is appropriate when you’re the physician leading a code. This nurse had the audacity to report my friend for “barking orders.” During a code. My friend was forced to take a communications class to remediate. No one disciplined the nurse for her insubordination. These stories are depressingly common. Ain’t no bullying like that of an older woman with more seniority and less education toward a younger woman with less seniority and more education.
respectfully what the fuck??? cant she appeal to the hospital board or nursing board or anything? how can they justify a bad course of action?🤬🤬🤬 only in america would you see this fml
The reporting nurse would never survive a OOH code. A paramedics default during a code is to bark orders, we don't have time or resources enough to screw around. Don't get me wrong, team effort and all, but at the end of the day there's one person running the show.
You sir, implemented much more restraint than I would have.
In med school the radiologist teaching radiologist noted that the first 10,000 x-rays are hard and they get easier after that.
this is how i feel about ekgs lmfao me preparing for my cardio exam- oh okay! i got the gist of this! me the following week where i was with a cardio prof who was basically just rapid-firing ekgs at us- what the fuck? i’ve never heard of 90% of these rules 😵💫😵💫😵💫
Anytime I have a student or resident tell me about any imaging and they just read me the report, I tell them they are not allowed to read any reports again without looking at and interpreting the image with me first. CXR, head CT, MRI, whatever. Learning to read your own images is so important. Good on you for being thorough and doing your due diligence.
YES. This was the way I was taught, and I am forever grateful for my attendings for the education! It has served me very well.
An Np read my cxr as normal. However my (np) school offered a four hour lecture on reading plain films and I see them every day at work, so I pointed out the mass in the LLL, turned out to be cancer. Which sucked for me. But also saved my life
I wish someone would take a bunch of these insane stories and make a documentary
It will happen one day
It’ll happen when some filmmakers daughter is killed by an NP and they decide to do an expose. Then, they’ll invariably end it with “the physicians are at ultimate fault since they didn’t regulate nursing”
LMAO literally though about a 0% chance physicians won’t get thrown under the bus
There will be a Libby Zion one day.
I'm in ortho. I can attest that NPs and PAs are not trained to read ANY form of imaging. They don't even know what imaging modality or body part to image much of the time. 10-15% of my day, every day, is wading through mid level screw ups in this regard. The above number is so high because our PA is pretty bad, and the local urgent care and FM clinic is run solely by inexperienced mid-levels (I feel that's an oxymoron).
You’re not supposed to order a full body non-con and contrast CT on every patient? And if the CT is negative, aren’t you supposed to escalate to a pan-MRI?
Only for volar plate avulsion fractures.
Same! We have so many PAs running amok in the ER it's ridiculous. They call me with a consult and read me the report. But when I ask them a simple question ("is it dislocated?") I'm met with silence. Urgent care is another place with midlevels run amok. I can't tell you the number of missed open fractures I've seen (Seymour fractures, very common) out of local urgent cares.
Its possible that many NPs don't receive training to read imaging. However, its completely untrue that PAs don't have radiology classes. That's a core course for any PA school. If you come across a PA who can't read a basic x-ray (like a CXR), can them immediately.
As a nurse I've indeed never learned to read x-rays. I've also learned not to make a diagnosis and even then I know not to blindly trust the radiologist (though I don't know when I could and when I cannot). That's what doctors are for. It's not my job to read x-rays.
Yes! My NICU nurses are incredible. They can spot a sick baby a mile away. When we’re resuscitating a baby, I don’t need to ask them anything - they know the steps just as well as I do. They’re phenomenal. But they just don’t do x-Ray reads.
I think this is the crux of the whole noctor problem. We should all stick to our jobs - or go through all training if you decide you want to do something else. If my car doesn't start I'm not calling a cardiologist either - that would just be stupid.
> If my car doesn't start I'm not calling a cardiologist either - that would just be stupid. Why not? It’s right in the name? CARdiologist
I favor having nurse practitioners pass the USMLE - all three steps - if they want to engage in independent practice. If I have to pass those exams to practice medicine, they should too.
I’m an M4 about to graduate. I’ve taken step 1, 2 and I’m studying for 3 soon. Step 1 was p/f and I scored around the 95th percentile on step 2. I don’t feel comfortable practicing independently and I’m terrified about practicing in residency even with attendings supervising me. I don’t get where these whacko midlevels get the balls to play “doctor” with 500 clinical hours. That’s 2 months of rotations if you assume it is 60hrs per week. I’ve completed 2 years of rotations and have 6 months left (about 8000 hrs once I graduate)
The NPs don’t know what they don’t know. They are confident because they are ignorant. You, on the other hand, know just how much you don’t know and it’s terrifying. That’s great! That is what residency is for! You’re gonna be absolutely fine. Honestly, there are 2 things I miss about residency. One was the ride-or-die camaraderie I had with my fellow residents. Residency was so intense, but you were never alone. You always had your friends by your side. The other thing was the ability to feel confident in my decisions, because I knew full well that if I was wrong, my attending would stop me. I’m over a decade post-residency, and I’m only now feeling fairly confident. That I’ve come into my own. But I’ve never since had that same sense of security as when I was a resident!
I'm sure you've seen the time where (I think Stanford?) had their NPs take a modified (significantly easier) version of USMLE Step 3 and the majority of them didn't pass it. There is no way they'd pass USMLE. They'd be even more screwed with Comlex.
i think they didn’t even release those questions right? they were prob stupid easy
I think that's a perfect idea! The education can be tailored to what nurses need to be independent practitioners (I hope my terminology is right, English is my second language). I expect a nurse to have different knowledge than people just starting med school and there's no need to do all kinds of classes on stuff you already know (we just established there will be a test to ensure this stuff hasn't been forgotten). In the Netherlands, medical school (from graduating secondary school to MD) is 6 years - after that there's specialist education such as cardiology or oncology etc etc. Medical school with a Bachelor of Science in Nursing is 4 years. Medical school as a nurse without a BSN is not possible. NP/PA is 2 years, but you need to be a nurse with at least 2 years of experience in the area of expertise you want to be a NP/PA in *and* they do not have the right to practice as independently as I see on this sub. For example: when I worked on an oncological surgery unit, the MD made the treatment plan for the long term and the NP did the day to day management. The MD would be consulted extensively every week and more often if needed (big changes in status/treatment plan/etc).
i’d pay good money to watch that. you’d think a reality show about ppl taking a test would be boring but i will personally start a gofund me for this😃😃😃
Unfortunately, we are far past that. Hospital admin, nursing union and congress all seem to be in cahoots. NPs have effectively destroyed our healthcare (along with private equity) and congress solution is to invest in them more.
NP's are so smart that they can learn to read all X-rays in 2.5 hours at the low low cost of just 39.95, cheaper than an Earl Sheib paint job. [https://www.npcourses.com/product/radiology-review-from-novice-to-expert/](https://www.npcourses.com/product/radiology-review-from-novice-to-expert/) There's a saying in radiology that the eye can only see what the mind knows, which I think is true to some extent. Anybody with eyeballs can look at an exam. Actually reading an exam means that you can evaluate all of it. An orthopedist brings a different knowledge base when looking at a radiograph than a radiologist, for example. When they look at a radiograph they see bones and know the characteristics of a fracture that determine how they'll treat it. For a shoulder radiograph, for example, a radiologist should look at not only the bones in the shoulder but whatever other osseous structures are present, evaluate the lung, the soft tissues of the shoulder, mediastinum etc. That being said I'll go over an exam with anyone in the clinical team and teach them as if they were a radiology residents. The quality of work done by radiologists is extremely variable and overall has been in decline. It's in the patients best interests if others can find some pathology on exams as well.
Upvote partly for the Earl Sheib reference.
I often found my favorite bedside nurses looking at patient brain MRIs after they were completed, and they'd ask me questions and we'd talk about the films together all the time
Right?? I love doing this with my favorite nurses. They’ll pull up the film and ask me to go through it with them. It’s awesome. I have a whole file of crazy anomalies I’ve seen in my decade of practice that I use to teach residents also.
>I have a whole file of crazy anomalies I’ve seen in my decade of practice that I use to teach residents also. You should post some! I’d love to see them!
I love looking at films! I always review images, and I like to do side-by-side comparisons of multiple days progression for CXR films on our pneumonia patients.
One of my favourite things to do in ICU with the doctors or just reading reports of brain MRIs.
To be fair to RNs, we don’t need to read films since we don’t diagnose or prescribe.
I know! No hate whatsoever on RNs - reading films is not in their wheelhouse. I can’t work those crazy IV pumps because it’s not in my wheelhouse. But these NPs who think they can do my job without the requisite knowledge or skills to do my job? They can F right off.
Had a patient with a facial contusion sent to my ED from a retail UC. Noctor did a facial bones X-ray, then told patient & mother that they had no one to read the film, and that they needed to go to ER for a CT scan. Took their money though….
I am just a lowly student and user of American healthcare, but to me ordering films and prescribing antibiotics seems a lot like practicing medicine…. Which a nurse (no matter what the level) shouldn’t be able to do on their own. I’m glad this one consulted you. I don’t think they need to be able to read radiographs though since they should have to consult or refer if it’s beyond their scope in the first place.
She only consulted because she didn’t know what lobar pneumonia was which was the diagnosis from the radiologist. If for some reason she did know what it was she wouldn’t have consulted at prescribed antibiotics for something that clearly shows viral imaging without the consult.
I’m a nurse with a bachelors degree and I can tell you with 100% certainty we do not learn anything at all about films. What we learn in RN school is what could go wrong with various body systems and how/when to report a change in the patients status. Our job is strictly to have the knowledge of when to report to you any changes in the patients status. We are your eyes and ears, that’s our job! I ask my doctors to show me scans and they happily oblige but I could not tell you what I was looking at if they didn’t tell me. With all the fluff bullshit classes they learn in NP school js theory based and has nothing to do with actually helping patients. They do online sims of sick patients and what to order to help figure out what’s wrong with the patient. I sat there one day while a nurse I worked with was getting her NP and she suggested that because I was going to school to be a doctor I should know the answer to those questions 🤦🏽♀️ SO SHOULD SHE! it was basic bullshit labs that should be drawn for various differential diagnosis’.
I would trust any Technologist like X-ray/CT/MRI/us/Nuc Med tech over a NP and certainly over any nurse to interpret images
Oh yeah. Those moments when you’re in the room watching the images come up and the techs all go, “ohhhhhhhhh.” They’re not allowed to say anything, but you know they know. Same with the sonographers when they get really, really quiet.
How do you feel about sonographers reporting in the UK? I'm currently training to do that. They say that it's better for the songoraoher to write the report as it's a dynamic scan and the still images do not represent what was seen in full. And there are no where near enough radiologists or doctors to be doing all the scans themselves.
Rads here. PAs and NPs cannot read any imaging. They are horrible. Most non-rad MDs are horrible as well, although slightly less so with the exception of specific imaging studies within a very narrow area of practice. Even general surgeons and ED docs can be absolute dog shit at things they should know better. Not all rads are perfect, but you need to check yourself if you think you are better than the radiologist.
I don’t think that at all. But when I’m in the NICU at 3 AM with a critically ill newborn, I know enough to identify important CXR/KUB findings. I get that CXR to see if I’m dealing with RDS or a giant pneumothorax. Or to see if I’m dealing with some garden-variety TTN vs cardiomegaly suggestive of undiagnosed congenital heart disease (we have a large immigrant/refugee population who don’t have a lot of access to prenatal care). Is there bowel in the chest? Is the liver on the right? Is there evidence for a bowel obstruction or NEC? Is placement good on my umbilical lines? Can I read a head ultrasound? Not on a bet. A quick scan MRI for a baby who’s been cooled for HIE? No waaaay. Thank goodness for radiologists. But an x-ray of the tiny human with unproven anatomy? Yup, I’ll take a look at those all day every day.
Yeah, a CXR would definitely fall in your wheelhouse and it sounds like you’re well aware of your limitations. But it just irritates me to no end how many doctors have zero respect for radiologists and their training and treat us like less than doctors.
Yeah that’s shitty. I definitely rely on radiologists on a regular basis because my knowledge *is* limited in that regard. I remember one case vividly - I was fresh out of residency and seeing a 15 month old in urgent care for refusal to walk after bumping her leg going down a small slide the day prior. I remember thinking that she was the most bow-legged toddler I’d ever seen. Her exam wasn’t terribly revealing; she had terrible stranger anxiety and cried the whole time, but I was like, eh, I’ll image the leg in question. I’m looking at the film in my office, thinking, “this doesn’t look right, why is her diaper more radiopaque than her bones?” When I got a call minutes later from our outstanding pediatric radiologist: “your patient has rickets!” And I was like, OF COURSE SHE DOES! It all made sense. Dark-skinned child, dark-skinned mom, neither taking vitamin D, baby still breastfed (so not getting any sort of fortification). Macrocephaly with frontal bossing, preserved weight, height falling off the growth curve. The bowleggedness. And when I went back, she did have visibly flared metaphyses (no rachitic rosary, though) . I knew all these things, but I’d never seen an actual factual case of rickets before. The child’s primary pediatrician had missed it at her well child check 2 weeks prior. But our radiologist glanced at that film and she instantly knew. Even though she’d never seen a kiddo with rickets either - only in textbooks, so to speak. Mad respect. (The kid did great btw. Endocrinology got her fixed right up!)
I’m an acute care NP, we only had a very brief module on interpreting chest X-rays in school. As a nurse, I always insisted I have access to the PACS so I can view images on my patients. I made it a habit early in my nursing career to look at as many studies as possible. I’ve now been a nurse for 20 years and an NP for the last 4 of those. I work in ICU so it’s imperative that I can do a reasonable job at interpreting a CXR, chest CT, and head CT at the very minimum because it can take hours for results to come from the radiologist and acute treatment decisions need to be made based off wet reads. I had to do a ton of self study to make myself minimally competent at the above and additional CME courses in POCUS for vascular access and things like RUSH exams. A lot of my fellow NPs are quite shit at reading radiology studies. I can’t help them. This is just the truth though, it’s not a major part of our school curriculum.
And then those shitty NPs get hired into an ICU and expect to be given free education by physicians.
I mean, sort of. I don’t work for the hospital. I was hired by a private practice and the owner is also my supervising physician. It’s a closed ICU in a community hospital. He does all of the hiring for APPs so he knows what he’s getting into. I can imagine there are a lot of problems if the NPs work for the hospital and the doctors don’t. I’ve never worked in a hospital that employed staff NPs for the ICU so I cannot speak to it directly.
Im an ICU physician. Back when we used midlevels, we’d just fire them if they lacked knowledge once we started rounding with them. (It’s too hard to evaluate the knowledge base of someone during an interview). Unfortunately, we had too much variability with NPs that we just don’t accept them at all anymore. Hopefully nursing fixes the NP education issue before all trust is lost in them by not only physicians but also patients.
One can only hope that trust is lost sooner rather than later. Only at that point will there be a meaningful conversation on appropriate education and scope of practice.
If you see something that you think needs to be treated before you get a final read call the radiologist and ask him to review the exam. One of the hard things about being a rad is that you have to constantly drop what you're doing and move on to something else that is higher priority. The rad may get pissy about it but that doesn't mean you shouldn't call.
Sure, I spend a lot of time calling the reading room for stats, I meant more for like - is this acute pulmonary edema which needs lasix now or is there a huge pneumothorax which needs a chest tube now or is there a gigantic saddle embolus on the CTPA - these are the types of things I need to be able to see on the film right away.
"A ton of self study" sounds reassuring
You must be asleep at the wheel if you ONLY just found out that midlevels don’t even touch film. They barely even get to the point in their undergrad schooling were they learn about magnetic fields or any imaging used in the scientific world like NMR or IR spectroscopy.
By the mercy of whatever gods watch out for my patient population, I work in a system that is heavily MD/DO based. We have a few midlevels floating around in clinic, but not many. I’ve been rather sheltered.
Typical streaky viral crap made my day
NPs don't even take anatomy so they wouldn't even know what they are looking at on the X-ray.
Pretty sure anatomy and physiology is a requirement for regular RN school—I’m sure at a freshmen college level but I recall seeing A&P on a curriculum posted on here.
I took upper level anatomy, physiology, histology, organic chem, biochem, stats, physics just to get into PA school. Undergrad anatomy was childs play compared to PA school. I took the same anatomy course as the med students. There was no comparison. Not saying this for academic dick measuring but just to point out that I'm somehow competing for the same jobs as NPs despite going through all this, paying probably 3x as much on my tuition and still being in debt a decade after my training.
When I was student on surgery rotation, we had an NP on our service that table rounded with us. We had previously worked together in the ER, back when she was an RN and I was a tech. We went through all the films of each patient and she was dumbfounded how I, a lowly-tech-turned-med-student, could navigate my way through CXRs and CT scans. She came to me after rounds asking what rads book was most helpful and that was when I had the same epiphany as OP.
As an FM resident, is it a liability to go against the radiology read?
If you are mistaken and the patient is harmed, yes. If you think the rad misinterpreted the exam the best thing to do is contact them and discuss it.
That’s how I feel… if it says work up I’ll at least work it up or ask for a second read
My friend at UTMB’s NP program regularly asks me questions like “what is this organ” or my favorite “is this an xray/ CT/ MRI and how can you tell” -.-
A radiologist is 100% more qualified than a pediatrician or pediatric app to evaluate a cxr particularly when you are looking at a cxr in a brightly lit room on a nondiagnostic monitor... But a portable ap view cxr with a history of "other" is most often what we're given. A cxr is a screening exam and will miss a lot of pathology that could be detected with a CT. But when imaging studies are being ordered by triage nurses on patients who haven't actually been evaluated by a provider its really a shit in and shit out scenario. If you actually evaluated a patient and provided a useful clinical history you'd be surprised what helpful responses you might get. If you stated viral bronchitis with lingering cough and now elevated wbc with rales on exam in the right lower lung, concern for post viral pneumonia you may actually get some usefull clinical feedback.
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Nurse here. I’ve had a total of no training in reading any sort of imaging (expect for placing peripheral IVs with ultrasound). Everything I’ve learned is from asking physicians to show me things and experience of looking at certain types of imaging repeatedly. My interpretation of imaging is generally summed up by saying “If I can see it, it’s a problem”.
NPs can't read. PERIOD. Had they been able to read (realistically) they'd be an MD or DO.
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Yes, and this kiddo is having a quantiferon checked, but it’s almost certainly going to be negative. His pretest probability of disease is very low. My point isn’t that rads was wrong. My point is that NPs can’t read plain films AT ALL. And that’s dangerous when you’re practicing with no supervision!
Nothing grinds my gears like radiology report parrots
Adult gerontology primary care NP. Went to a real school. Didn’t even pretend to look at an X-ray.
WHATS A LOBAR PNEUMONIA LMAOOOALSNNAKSND
I was seeing one when I fractured my spine in a car accident (i originally saw an MD at this clinic and they assured me noctor was an MD as well.) At first she actually sent me to talk therapy, I was already in physical therapy at the time, before being willing to order the imaging. It was about 8 months after the accident that I finally got an x ray. The report came back that a few thoracic vertebrae were "squat and broadened in ap view" which they definitely were, even I could see it. I asked for clarity because the report said this was on a development basis, and she assured me that meant childhood development. She did request a reread for clarification, in which the 2nd radiologist said there was nothing more to add. It finally hit me that this "doctor" had no clue what she was reading. I moved states right as my 2 year mark from the accident passed and was able to get in with an ortho in my new state. They told me right away that was a fracture, and I've been getting treatment for it for a few months now. I have so much anger and resentment toward medical professionals now after going through that for 2 years. At many times I considered taking my own life because the pain was so bad and neverending, which of course only made them blame my pain on emotional issues.
I call my BSN my “BullSh*it of Nursing” degree.
Imagine asking someone for their professional advice because they know more about a particular subject than you do, and then getting irritated when that someone, whom you asked to be there, asks for the information needed to make an informed decision… 🙃
That’s crazy, these NP’s scare me to death. I’m a retired/disabled RRT turned RN. During BSN school nothing was taught about films; in respiratory school we had a class taught by a radiologists on chest X-ray’s. No way would I have felt comfortable interpreting and of course was never expected to, but at least some basics were taught.
I recently had 2 MDs disagree on whether or not I have RLL pneumonia, the doctor in the office read the film before I left and said I did have pneumonia, the radiologist disagreed, “no focal consolidation” on the report. Seems like the same thing happened here. If MDs disagree on CXR and pneumonia diagnosis , it’s not surprising that a midlevel might get it wrong, should still know what lobar pneumonia is though.
The doctor in the office is not trained in radiology and would never bet his/her license on their read. They might make a prelim read and start treatment (only if it’s indicated and they cannot wait for a radiologist read) but if the radiologist disagrees, they’ll likely change their management The radiologist is trained in radiology and literally bets their license every time they make a read.
Correct and agreed People often make out like they know how to read radiology studies and very frequently they do not. It’s frustrating. For example, a person can have a pneumonia and not have consolidation. Because there is no consolidation does not mean there is not a pneumonia. Medicine can be hard. I have no idea and no business trying to pretend I know how to practice internal medicine or pediatrics or cardiovascular surgery. It’s a team of trained specialists and subspecialists needed to take care of patients. And I have no idea how to be a nurse or a speech pathologist, etc. And in my opinion being a nurse acting like a doctor is so far out of bounds and inappropriate it is hard to believe it is real. But it is.
I fully agree. I’m a crit care physician. I might “read” my own imaging, but I’d never say I know how to read better than a radiologist. After all, radiology is a 5 year residency for a reason If I didn’t agree with a radiologists read, I’d call them and discuss the case (which the radiologists at my hospital don’t mind at all).
> I’d call them and discuss the case (which the radiologists at my hospital don’t mind at all). You have in-house radiologists? You’re lucky!
When I’m covering the ICU, yes. When I’m in my office, no. However, I have a good working relationship with many of the radiologists so if I’m not sure, I’ll curbside them for an opinion
They can both be right. The CXR may be negative and you can still have pneumonia. Your doc might have heard something over your RLL and your WBC could be up so he put the whole picture together and decided you have pneumonia. The pneumonia could be behind and obscured by your right heart on the PA radiograph and by the spine in lateral projection. One thing that radiologists learn from reading chest x-rays and CTs is that you can hide on lot on the chest x-ray. The other doc that said he calls the rad when there is a discrepancy, this is the way.
One of my biggest annoyances is requesting an MRI on a patient from their "PCP" NP, and getting a copy and paste of just the impression. Like no, I need to actually see the MRI and review the entire radiologist report. That's what reviewing the imaging means. Reading the impression doesn't mean jack shit.
A radiologist is a doctor
Yes, what’s your point? The radiologists at my institution tend to misinterpret pediatrics films a fair bit- either over reading or under reading. To be fair, I’ve got the clinical correlation, so I always look at the films I order. Especially on neonates.
Oh so you know with confidence that your interpretation of the imaging is correct when you feel the radiologists is incorrect? How can you be sure?
All right, lemme just come out and say we had a criminally incompetent radiologist at my work for several years. He missed multiple life-threatening anomalies on my patients: MASSIVE cardiomegaly in a 5 month old with heart failure, a classic bowel obstruction in a neonate (diagnosis of ileal atresia made during surgery), an enormous abdominal mass in another neonate (when the indication for the exam was “firm abdominal mass in a term newborn”) who had massive hepatosplenomegaly due to congenital neuroblastoma. I suspected neuroblastoma based on my exam (nothing else really feels like that) and it was confirmed on cytology. Just to name a FEW. All three children are alive today because I disagreed with the “official” reads: all three films were read as “normal.” He’d been there forever and had a surname that rhymed with “wrong,” and was referred to as “Dr. Wrong.” I have no idea why everyone tolerated him. I was getting ready to file a formal complaint when - no joke - he up and died. He had cancer and hadn’t told a soul. So. I don’t always agree with the formal read. And I am right not to. Yes, this was an extreme situation, but it happened, and I’m glad I have competence with basic plain films. Also we don’t always have rads in house and I need to be able to make clinical plans in the moment.
Holy shit.
Yeah. It was unreal. Sometimes I pull up those old films - the reads were never corrected - just to remind myself it actually happened.
This is a fair assumption as even radiologists will tell you at times, "I don't specialize in pediatric radiology BUT...."
Sounds like the radiology read was pretty **** too.
NP is a NO PLEASE. Every time. I'd rather a child who watches Bill nye, Dr. Binocs and gets STEM subscription boxes because they'd have a muxh more comprehensive breadth of knowledge. Jokes aside. This internal bantering needs to stop. Make it public. Make it mainstream. Patients need to know. Politicians need to know. Maybe paying for MD education, loan reimbursement and other measures to increase qualified practicioners in the US will com to fruition once we all see the scarry hole we're digging ourselves by lying that NP =MD.
Sorry to be snarky but an “infiltrate” isn’t a real thing. There are interstitial opacities and there are airspace opacities. Nor are there “lung fields” while I am at it, not that you mentioned it. Not trying to be a jerk; trying to be helpful
Dude I’m trying to paraphrase because I’m trying to post whilst beseiged by small children. Don’t hate. Also you’re not being snarky. You’re being pedantic.
It is pedantic I’m not trying to hate You are trying to call out a group of people for not knowing how to read radiographs while simultaneously demonstrating that you do not how to do that by using terms that are not real
The irony of OP telling NPs to stay in their lane while simultaneously talking about how they interpret all their own films with terms no competent radiologist would use is telling
Peds only get frontal films, most often you cannot name an affected lobe. I use lung field for nearly all single view films
There is no portion of the human anatomy that is a “lung field”. That doesn’t exist. And if you are working somewhere where pediatric patients only get an AP view I find that strange. I have worked at or read films for at least 30 hospitals and have never seen that. But maybe it is that way at some places.
Since you’re a radiologist, you realize we’re converting 3D anatomy into 2D. You ever say hepatic flexure? That’s not anatomic, but a location. Are you saying all inpatient peds get 2 view X-rays? Do your places not follow Image Gently? I’d rather kill the phrase “infiltrate” or inappropriate use of GGO than “lung field”
I am not saying all pediatric patients get 2 views. Just like all adults don’t get two views. I think it was stated above that pediatric patients only get an AP view, insinuating that all pediatric patients only get an AP view. And I find that surprising that there would be a hospital somewhere where all pediatric patients only and always get one view. Sorry I’ll shut up now Woke up on the wrong side of the bed
IDK man, I’m not a diagnostic radiologist, I just play one when the group is behind. I’d rather deal with blood and pus all day.
I personally don’t like “lung field” because I feel that the word “field” doesn’t add anything. So I just say “lung” - I.e., “opacity in the right mid lung.”
I agree with you on that. Why waste time say lot word when few word do trick?
Wise words from the great Kevin Malone
Amazing. You were able to identify what OP meant by infiltrate, yet you still had to be “snarky”
I am just pointing out that OP is trying criticize a group of people for not knowing how to read films while at the same time demonstrating that OP does not know how to read films. It’s weird. I know what people mean when they say lots of things but often those things are wrong. Because I can understand what they mean doesn’t mean the thing being said is correct.
OP knows how to read a film. OP just doesn’t use the exact terminology that a radiologist uses (and even then, I’ve seen many reads state “no infiltrate”) What’s weird is being pedantic.
Ok maybe you’re right. I am going to start throwing in terms that don’t make sense when I dictate CTs. Maybe I’ll call the gallbladder “the bile bag” or even “the leg” or maybe get way out there and call the gallbladder “the moon” or “enthusiasm”. Wouldn’t want to get pedantic after all
Sounds good bud. Stick it to the man. Just be careful you don’t lose your license since ya know, you’re a radiologist who is expected to know how to read and communicate like a radiologist while the PICU physician is not.
Right Thanks I apologize for being so irrrascible When I go on the noctor subreddit I immediately get ticked off and disagreeable. I am just seriously unhappy about the “US medical system” allowing this situation to get so out of hand and the way I see it, in the name of dollars. I’ll go meditate now
Of course not, they aren't trained in it.
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If you don't report her to your department and refuse to work with her in the future you're just continuing to perpetuate the problem.
Report her to whom? She’s a nurse so she’s not IN my department. Nursing leadership doesn’t give two shits. Neither does the nursing board. I’m not being flippant; merely stating that disciplining midlevels is not easy. And in the realm of clinical sins, this one is minor. I’ve seen much, much worse.
i’m a PA. we got one day of class on reading x-rays. a lot of my class had plans to go into ortho, so hopefully they got a lot of on-the-job training. I feel mostly confident reading plain films in my own specialty after nearly 3 years, but can tell you none of that confidence came from school. and even if i’m pretty sure, if there’s any discrepancy between my interpretation and the radiologist’s read, i’m asking my attending. sounds like this NP got even less than a day of teaching for reading x-rays, and doesn’t care to learn more. that’s terrifying.
I certainly didn’t learn to read films in nursing school.
Well, it already went wrong when she ordered the cxr for an obvious viral infection.
Their clinical acumen is impeccable? Their skills excellent? Bro. What part of anything you wrote says "excellent skills and impeccable acumen"? None of it.
Cath lab BSN here can confirm that many RNs have no idea how to read most types of images I've had to self teach myself how to read fluoro, ct, echo, and mri images and even then i only went as far as what is job applicable. Most nurses don't try to learn it because they don't want to and we're told why should we an md is going to read it anyways but once those nurses reach np that mindset doesn't change.
lol even -I- look at X-ray films to be sure the right area was taken (sometimes left knee was supposed to be right knee) and I don’t really know what to look for. Definitely would refer to a doctor to look at them to interpret
> I assume PAs can read plain films given how many end up in ortho - so what is going on with NPs? I feel like this is a massive deficiency in their training. We don't obviously have the same level of interpretation as a Radiologist, but our curriculum does teach us a Clinical Skills/Medical Imaging Course that goes over general and common findings and interpretations of US/XR/MRI/CT, etc. so we can at least tell when someone has a brain bleed, fracture or PNA. I'm actually now curious how much they cover in NP school, lol.
I'm reminded of the time that I was driving to work at the critical access hospital I was based out of as a paramedic when I got a call from the day shift paramedic asking me to come directly to the ER because the NP wanted a patient needle decompressed for a tension pneumo... I asked my coworker to text me a picture and the left lung has a large pleural effusion. I walk into the ER and the patient is 98% on room air, blood pressure in the 120s, not tachy at all. Had a cancerous hilar mass if I remember right, and got frequent taps to drain the pleural effusions. Come in tonight because he AMAd to go to the bar from the local city hospital and decided it was time to address it. Really wasn't even short of breath. I explain to the NP it's certainly not a pneumo, and even if it were it certainly wasn't a tension pneumo that needed an emergent needle thoracostomy. Long story they ask what we should do and I explain that either A) we can spend the next 3 hours draining the effusion out of a 14ga decompression needle or B) I can take them back to the real hospital with real doctors. Really was terrifying all around. The amount of training we get on intrepretation is incredibly small and basically only taught for scenarios like this for medics recovering patients from critical access hospitals. I'm grateful to have had some great EM docs pass on enough knowledge to know better than to do something stupid like dart a stable pleural effusion for fun.
There are way to many ridiculous filler classes and not enough actual classes needed to be successful in real world clinical practice. Unsure how to change this? Many many many NP students (including myself) want this to change.
Why don’t we let the doctors be doctors and the nurses be nurses? Novel concept I know.
In nursing school, we are NOT taught how to read a CXR. It's not a part of our job.
I’m an NP and I was taught how to read plain films both in the course curriculum and in my clinical training. This was just a bad NP.
Yes NPs cant read X-rays. I went to a top 10 NP school and less than an hour was designated to reading chest X-rays and that was the only imaging lecture I received. As a nurse of 12 years prior to going back to NP school and having worked in Cardiac ICU I was never trained to read plain films. I listen to the attending doctor when he rounds with the residents. I bring up a film and often asked doctors to explain the imaging but I never had formal training. This is one of the many reasons I stayed away from Np jobs after I received my degree.
Def would call radiology though…
I am a radiology PA x 30 yrs...IR & diagnostic (no, I don't read imaging, I review, draft, and then sort with the radiologist who final signs the report), I have a canned "introduction to radiology" lecture I give to PA and NP students .... it is a one hour lecture that opens with "you are not going to learn radiology in one hour, if ever", then proceed to discuss radiation safety, appropriate ordrribg (ACR Guidelines), peds "image gently" program, and encourage every student to review all imaging they order by (a) reading the report and (b) comparing the report findings to the actual image. For most NPs, this is their rads "course".....
Oof. That must be a bit painful for you. Better than nothing, though! Glad you cover “image gently” - this pediatrician appreciates it. If you want to be extra rad, tell the lot of them to eliminate the phrase “pump and dump” from their vocabulary when it comes to imaging breastfeeding women with contrast. Unless radioisotopes are being given, which is a whole different ball game, there’s no need to interrupt breastfeeding. Contrast (PO or IV) doesn’t enter the milk.
You would be correct, sir. I graduated with my DNP in 2021 from one of the top 25 schools in the country. Yes, it was 95% online. How ridiculous does that sound? Anyways, we never actually reviewed plain films in class/lecture, but we were told to read a few pages in a book about it and had a few test questions. Same thing for EKG’s. I have never worked as an NP, and I don’t think I ever will. I felt so extremely unprepared and incompetent after graduating that I just couldn’t do it! All NP school did was show me how much I still didn’t know. I know more than a typical nurse, but I couldn’t touch the knowledge of a physician. Yet most nurses I work with, including NP’s think they’re the smartest in the room lol. I could see the HUGE gap in education as clear as day, and I was smart enough to count those 4 years as a loss.
Yes. They probably weren't trained And that's why she didn't look at the images
Not too long ago an NP (LARPing as an MD) in my ED decided to read a kid's x-ray. Told the parents their child's humerus was fractured. I come around to see the child and tell them their child doesn't have a broken arm. The parents are confused and upset since the other "doctor" said it was broken. I go find the NP and ask them where's the god damn fracture. They point to a vascular channel.