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WATCH: An NP and Resident Get Real About the Difference Between Their Work

An NP and a resident physician walk into a… film studio. What do they talk about?

That’s the premise of a new video from BoardVitals, a medical specialty board certification preparation firm. It puts Mike Natter, MD, internal medicine resident in New York City, and Danielle Leveck, DNP, ACNPC-AG, CCNS, RN, CCRN, who works in a cardiovascular surgical ICU in Ohio, face-to-face to discuss issues like NP practice restrictions, resident pay and more.

How does residents’ and NPs’ practice autonomy compare?

Dr. Natter kicked off the conversation by asking Dr. Leveck how much assistance NPs need — at his hospital, he often sees them rounding with attendings, he explained.

“I think it really depends on where you work, honestly. The previous institution where I worked, NPs rounded with everyone, they formulated their own plans of care. It was multidisciplinary,” Dr. Leveck answered.

“The institution where I am now, we don’t really do a lot of rounding,” she continued. “We go in, we see our own patients, we develop our own plans of care. We will bounce ideas off the physicians or other NPs, but we do practice in autonomous fashion. But technically, in the state where I’m living now, in Ohio, the law says we can’t be completely autonomous.”

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She added that many hospitals will require sign-off by a physician for some NPs, even if the state doesn’t.

Dr. Natter then moved on to his own experience with NPs: “We have an APP team and the attending rounds with them, which seems parallel to what I’m experiencing as a resident. I make up my own plan, I round with an attending and staff it with them. But you don’t necessarily need that as an NP, do you?”

“NPs can be autonomous, but in healthcare, you’re going to bounce ideas off each other and talk to each other,” Dr. Leveck responded. 

How does residents’ and NPs’ work compare?

Drs. Natter and Leveck pretty much immediately agreed that many of their day-to-day tasks are similar, even though, “we don’t train anything close to the same,” Dr. Leveck clarified.

“Very rarely am I working directly with an NP. They have a series of patients and I have a series of patients,” Dr. Natter added. 

“It varies by state, institution and area of practice, but in general, we do a lot of things physicians do,” Dr. Leveck continued. “They call us an extender of care, however I don’t know if that’s an appropriate term because a lot of the time, we’re splitting the workload.”

Then she dove into a responsibility unique NPs: “We’re a constant, when it comes to care.  Residents and attendings tend to rotate, but there’s always an NP on the unit typically … We do a lot of tying up loose ends, coordinating care, transferring patients, finding out where they go after the hospital, a lot of transitioning of care.”

How does NPs’ and residents’ quality of life compare?

The pair agreed that NPs get the better end of the deal because, unlike residents, they’re no longer in training.

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“Full-time for me is three, twelve-hour shifts a week, but they usually end up being 13 or 14 hours.” Dr. Leveck said. “We can work six days on, six days off. You may … need a day and a half to recover, but once you finish, you have five days where you’re a functioning human being … I’ve noticed it myself that I get far more vacation time than the doctors I work with.”

Natter kept his response simple: “At my institution, my understanding is the NPs do quite well, whereas the residents, we have very little income and we work horrendous schedules. I think the NP definitely has the better schedule and better income, so we’ll leave it at that.”

What are the biggest differences you’ve noticed between NPs and residents? Share your thoughts in the comments below.

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