Nurse Practitioner as a replacement RE?

pinkdoggie · December 2014

Good morning everyone (it's Friday, woot)

I go to a PCOS support group once a month and last night one of the gals there was talking about how she started to see a nurse practioner who specializes in fertility instead of an RE. I almost objected but realize I don't have much knowledge on the subject. Anyone have any opinion on this? I'm just curious if going to them is the same as going to an RE?

Edited for typos

LindseyM2012 · December 2014

Nurse practitioners are not doctors. They have medical knowledge and have the ability to prescribe medications, but they have been through nursing school and have obtained a masters degree in nursing. Even with additional nursing training, they have not been through medical school. And they certainly haven't been through the fellowship after medical school that REs complete. I would advise against it.

Nurse practitioners are a good option for the more common, lower level medical things - flu, strep throat, ear infections, etc. (anything for which you might go to a CVS Minute Clinic). I would HIGHLY advise against seeing an NP for fertility. Probably comparable to an ob/gyn for fertility with less training (no med school completion).

bookworm40 · December 2014

I saw my RE on the initial consult and have been back twice and have seen the Nurse Practitioner both times. The first time I saw her she knew my case inside and out and so I felt very comfortable with her.

LindseyM2012 · December 2014

Cupcakegal930 said:

I saw my RE on the initial consult and have been back twice and have seen the Nurse Practitioner both times. The first time I saw her she knew my case inside and out and so I felt very comfortable with her.

You make a good distinction here that your NP is working with your RE. @pinkdoggie - did the person you're referring to JUST see an NP or is the NP the nurse with the RE's office? I think most of us working with REs have much more contact with our nurses than the RE, but that nurse is not making the treatment decisions. That nurse is just carrying out the REs orders.

kushie77 · December 2014

I see the NP who collaborates with my RE for most visits. I only saw the RE at my initial consult. She is the one who has done all my US and did my SIS. She works hand in hand with the RE, maybe that's what the girl in your support group was talking about. IDK how it is elsewhere but in PA an NP must have a collaborative agreement with a doctor who specializes in her field of practice in order to practice or write any RX.

dancerspose · December 2014

I second pretty much what everyone else has said. Other than preliminary, diagnosis, surgery related, and WTF appointments I never see my RE, but all my monitoring appointments are done by either NPs and PAs who work in the practice. I think that's pretty common so that the doctors' time is freed up for the more complicated matters. In that case, I think it's totally fine.

However, if someone is seeing ONLY an NP I would suggest extreme caution for the same reasons others have already mentioned.

BunnyBerry · December 2014

The RE has done our consults pre/post-surgery, and determining treatment changes. He reads the bloodwork/ultraound results and decides dosing. At times he confirms trigger date or next monitoring date if the nurse is iffy. He answers my questions through the nurses when I have them.

The nurses do everything else - answer my questions, train on injects, do IUIs, consult after each ultrasound, determine monitoring/trigger/IUI schedule, and wash the sperm for IUI (btw, is this normal??).

I wouldn't want to be paying an MD to check my hoo-ha every step of the way, but I also wouldn't want to leave my fertility up to a nurse's best guess based on experience only.

MissK23 · December 2014

In my experience I think it depends on the office you're working with. The clinic I go to has both NP's and RE's that deal with patient care. The NP's handle the less invasive protocols (clomid/Letrozole) and the RE's handle IUI's, IVF and the rest. Since I am new to the game I work with an NP at the clinic to do my medicated, timed intercourse cycle, but if I don't respond well or need to move to IUI/IVF then I'll work with an RE. I had an RE do my HSG, but my NP does my ultrasounds and goes over protocols and prescribes my meds to me. I would hope that this is the case for your friend, in my experice all NP's have to work in conjunction with an MD, let's just hope that in this case that MD is and RE, not an OBGYN.

pinkdoggie · December 2014

Hey guys, sorry for posting then running off all day haha. The way she was telling the NP had her own office and she worked with (like called) the reproductive medicine place if she had questions. SOunded kinda weird to me.

pinkdoggie · December 2014

hahaha @BlueFairy5 that's exactly what I was thinking.

AnonymousNurse · December 2014

LindseyM2012 said:

Nurse practitioners are not doctors. They have medical knowledge and have the ability to prescribe medications, but they have been through nursing school and have obtained a masters degree in nursing. Even with additional nursing training, they have not been through medical school. And they certainly haven't been through the fellowship after medical school that REs complete. I would advise against it.

Nurse practitioners are a good option for the more common, lower level medical things - flu, strep throat, ear infections, etc. (anything for which you might go to a CVS Minute Clinic). I would HIGHLY advise against seeing an NP for fertility. Probably comparable to an ob/gyn for fertility with less training (no med school completion).

As an NP student, I have to get on my soap box for a second and correct your impression of NPs. Their scope of practice goes far beyond throat cultures and antibiotic prescriptions. There are NPs on every service in the hospital - Neurosurgery NPs, Critical Care NPs, etc - as well as Master's prepared nurses (CRNAs) that are licensed provide anesthesia/intubate, etc. Reducing the entire to profession to "anything for which you might go to a CVS Minute Clinic" shows a high level of ignorance on your part. I'm sure you didn't mean any offense but I couldn't let your comments go without correcting you. </rant>

That being said, everyone is totally right. I always see the NP at my RE's clinic (she did both of my IUIs, she does all my ultrasounds, etc). She is wonderful. However, my RE is the one that made my treatment plan and he is consulted with any changes. I am still more directly under his care. Like others have said, an NP that "specializes" in fertility (this is not a real specialization for NPs) is just as bad or worse than seeing an OB.

LindseyM2012 · December 2014

mbrookeRN said:

LindseyM2012 said:

Nurse practitioners are not doctors. They have medical knowledge and have the ability to prescribe medications, but they have been through nursing school and have obtained a masters degree in nursing. Even with additional nursing training, they have not been through medical school. And they certainly haven't been through the fellowship after medical school that REs complete. I would advise against it.

Nurse practitioners are a good option for the more common, lower level medical things - flu, strep throat, ear infections, etc. (anything for which you might go to a CVS Minute Clinic). I would HIGHLY advise against seeing an NP for fertility. Probably comparable to an ob/gyn for fertility with less training (no med school completion).

As an NP student, I have to get on my soap box for a second and correct your impression of NPs. Their scope of practice goes far beyond throat cultures and antibiotic prescriptions. There are NPs on every service in the hospital - Neurosurgery NPs, Critical Care NPs, etc - as well as Master's prepared nurses (CRNAs) that are licensed provide anesthesia/intubate, etc. Reducing the entire to profession to "anything for which you might go to a CVS Minute Clinic" shows a high level of ignorance on your part. I'm sure you didn't mean any offense but I couldn't let your comments go without correcting you. </rant>

That being said, everyone is totally right. I always see the NP at my RE's clinic (she did both of my IUIs, she does all my ultrasounds, etc). She is wonderful. However, my RE is the one that made my treatment plan and he is consulted with any changes. I am still more directly under his care. Like others have said, an NP that "specializes" in fertility (this is not a real specialization for NPs) is just as bad or worse than seeing an OB.

I certainly didn't mean any offense and I do appreciate your input. I didn't mean to reduce the entire profession to something lesser. In my opinion, seeing an NP that is directly working within an REs office is an entirely different story than seeing an NP who has their own office (without direct collaboration with an RE). If I personally were to see an NP outside of an office with an MD, it would be limited to more common illnesses that I would go to a General Family Practitioner (assuming the illness is not too serious) not a condition that requires a very specialized MD. I would be more comfortable seeing an NP within an REs office for less invasive procedures when the RE has made my treatment plan (as I said in my 2nd post on this thread, I think the majority of us do this now). I do appreciate the additional education and expertise of NPs, but I think people should know the difference between an NP and an MD. They are not the same - different routes of education, different skill sets, etc. That is not to reduce the qualifications of NPs but an effort to be educated about who is providing the care I need. This is my personal preference.

I hope that clarifies my comments. Again, I didn't intend any offense.

Edited for wording.

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Nurse Practitioner as a replacement RE?

Re: Nurse Practitioner as a replacement RE?

March 2014 - RE appt.
April 2014- Saline sono all's good, terrible SA results - 8 sperm found all abnormal
May 2014- Fert Urology- Bilateral varicoceles, recommend Donor Sperm

12/2014- Surprise natural BFP EDD 7/31/15 Plan: Starting foster to adoption, natural cycles

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Nurse Practitioner as a replacement RE?

Re: Nurse Practitioner as a replacement RE?

March 2014 - RE appt. April 2014- Saline sono all's good, terrible SA results - 8 sperm found all abnormalMay 2014- Fert Urology- Bilateral varicoceles, recommend Donor Sperm

12/2014- Surprise natural BFP EDD 7/31/15 Plan: Starting foster to adoption, natural cycles

Choose Another Board

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March 2014 - RE appt.
April 2014- Saline sono all's good, terrible SA results - 8 sperm found all abnormal
May 2014- Fert Urology- Bilateral varicoceles, recommend Donor Sperm