a doctor seems like overkill. Why not have many of the doctoring upsides while avoiding

一個醫生似乎是矯枉過正。為什麼不在擁有許多醫生的優點的同時避免

many of the doctoring downsides. Here's how you can decide if becoming an NP is a

許多做醫生的缺點。下面是你如何決定成為一名國家護士是否是一個

good career for you. Dr. Jubbal, MedSchoolInsiders.com.

對你來說是個好職業。Jubbal博士，MedSchoolInsiders.com。

Welcome to our next installment in So You Want to Be. In this series, we highlight a

歡迎來到《你想成為什麼樣的人》的下一期節目。在這個系列中，我們將重點介紹一個

specific specialty or profession within medicine, such as nurse practitioner, and help you decide

醫學中的特定專業或職業，如執業護士，並幫助你決定

if it's a good fit for you. You can find the other videos on our So You Want to Be

如果它很適合你。你可以在我們的 "你想成為 "欄目中找到其他視頻。

playlist. And make sure you're subscribed if you want to vote for future videos.

播放列表。如果你想為未來的視頻投票，請確保你已經訂閱了。

Before we dive in, note that as with all my So You Want to Be videos, this video was created

在我們開始之前，請注意，與我所有的 "你想成為什麼樣的人 "視頻一樣，這段視頻是由我創建的。

with input from experts in the field. After all, I'm an MD, not an NP, and I relied on

有該領域專家的意見。畢竟，我是一名醫學博士，而不是一名國家護士，我依靠的是

practicing NP input for guidance and accuracy. What is Being a Nurse Practitioner?

執業的NP輸入的指導和準確性。什麼是作為一名執業護士？

A nurse practitioner is an advanced practice registered nurse and a type of mid-level practitioner,

執業護士是高級執業註冊護士，是中級執業醫師的一種類型。

similar to yet distinct from a physician assistant, which we covered in a previous episode.

與醫生助理相似，但又有區別，我們在上一集講過。

NP's assess a patient's needs, order and interpret tests, diagnose conditions, and formulate

護士長評估病人的需求，訂購和解釋測試，診斷病情，並制定方案。

and prescribe treatment plans. Their training covers disease prevention, patient education,

並開出治療計劃。他們的培訓包括疾病預防、病人教育。

managing acute and chronic conditions, and coordination of care, but they are not trained

管理急性和慢性疾病，以及協調護理，但他們沒有受過培訓。

to the same extent as MD's or DO's, and therefore may not be able to recognize and manage more

醫學博士或醫學博士的程度相同，是以可能無法識別和管理更多的問題。

complex and nuanced conditions straight out from graduation. Do note, however, that after

複雜和細微的條件，從畢業後直接出來。然而，請注意，在

working with supervising physicians for some number of years, they may be better equipped

與主管醫生一起工作若干年後，他們可能會有更好的裝備。

to handle more complex levels of care. Similar to the physician assistant profession,

以處理更復雜的護理水準。類似於醫生助理的職業。

the first nurse practitioner program was developed in the 1960's to address the shortage of primary

第一個執業護士計劃是在1960年代制定的，目的是解決初級護士短缺的問題。

care physicians, particularly in rural areas, which were most heavily impacted. By the 1970's,

護理醫生，特別是在農村地區，受到的影響最嚴重。到了1970年代。

there were approximately 15,000 NP's across the United States, and by the late 1990's,

全美國大約有15,000家NP，到20世紀90年代末。

close to 70,000. There are currently over 250,000 nurse practitioners in the U.S.

接近70,000人。目前在美國有超過25萬名執業護士。

The scope of practice for an NP varies, and in some states they must work under the supervision

非執業醫師的執業範圍各不相同，在一些州他們必須在監督下工作。

of a physician, whereas in others they can practice independently. The scope of NP work

而在其他國家，他們可以獨立執業。非執業醫師的工作範圍

has not been clearly defined, and is not only dependent on state legislature, but also on

還沒有明確的定義，不僅取決於州立法機構，而且還取決於

what the supervising physician is comfortable with.

監管醫生所能接受的。

In terms of specialization, it's not a matter of choosing a residency or a fellowship. The

在專業化方面，這不是一個選擇住院醫生或獎學金的問題。的問題。

NP education model is more focused from the beginning, and you should therefore attend

NP教育模式從一開始就比較集中，是以你應該參加

a program that caters to your intended area of specialization. These areas include primary

一個適合你的專業領域的方案。這些領域包括初級

care, acute care, family, women's health, neonatal, emergency, pediatric acute, pediatric

護理、急症護理、家庭、婦女健康、新生兒、急診、小兒急症、小兒

primary, and surgery. If an NP school has multiple programs, they may allow for flexibility

初級，和外科。如果一個國家護士學校有多個項目，他們可能會允許有靈活性

in changing, as the first year is more general education. But this is an important caveat

在改變，因為第一年是更多的普通教育。但這是一個重要的注意點

to note – your future practice and specialization will largely depend on the NP program you

需要注意的是--你未來的實踐和專業將在很大程度上取決於你的非執業醫師計劃。

attend. In comparison, the medical school you attend has comparatively little influence

參加。相比之下，你就讀的醫學院的影響相對較小

on the specialty you may pursue as a physician. And similar to physician assistants, if you

在你作為一個醫生可能從事的專業上。與醫生助理類似，如果你

go into the operating room, you'll be first assist as a nurse practitioner, not actually

進入手術室，你將作為執業護士的第一助手，而不是真正的

doing the surgery, which is the role of the surgeon.

做手術，這是外科醫生的職責。

Nurse Practitioner Myths There's a broad range of myths that confuse

執業護士的迷思 有廣泛的迷思混淆了

pre-health students considering a career in healthcare. Let's set the record straight.

考慮從事醫療保健工作的預科生。讓我們把話說清楚。

First, contrary to what some people think, becoming a nurse practitioner isn't simply

首先，與一些人的想法相反，成為一名執業護士並不是簡單的

a matter of being an RN for long enough. It requires separate training.

一個做了足夠長時間的護士的問題。它需要單獨的培訓。

Second, many lump physician assistants and nurse practitioners in a single bucket as

第二，許多人把醫生助理和護士長混為一談。

"doctor lite", but they're under two different training models. Physician assistants go through

"平裝醫生"，但他們是在兩種不同的培訓模式下。內科醫生助理要經過

the medical model, while nurse practitioners build upon the nursing model. While they do

醫學模式，而執業護士則建立在護理模式的基礎上。雖然他們是

have many similarities as mid-level providers, they are distinct entities.

作為中級提供者有許多相似之處，它們是不同的實體。

Third, the DNP degree stands for doctor of nursing practice, but that doesn't make them

第三，DNP學位代表的是護理實踐博士，但這並不意味著他們

physicians. As the term "doctor" generally indicates "physician" in the clinical setting,

醫師。由於 "醫生 "一詞在臨床上一般表示 "內科醫生"。

many find it misleading for a DNP to introduce themself to patients as a doctor, and many

許多人認為DNP將自己作為醫生介紹給病人是一種誤導。

states have legislation prohibiting this. This is an area of controversy. While nurse

各州都有立法禁止這樣做。這是一個存在爭議的領域。雖然護士

practitioners are intelligent, capable, and contribute greatly to the healthcare system,

從業人員是聰明的、有能力的，對醫療系統有很大貢獻。

they are not physicians and do not receive the same level of training. On one hand, most

他們不是醫生，也沒有接受過同樣水準的培訓。一方面，大多數

physicians are against NP's calling themselves doctors, as it leads to patient confusion

醫生們反對非執業醫師自稱醫生，因為這將導致病人的混淆。

and obfuscation of roles. On the other hand, some NP's argue they've worked hard for their

和角色的模糊化。另一方面，一些NP認為，他們已經為自己的

degree and want the right to call themselves "doctor". My NP colleagues, who helped in

學位，並希望有權稱自己為 "醫生"。我的非執業醫師同事們，他們在幫助

the creation of this video, believe that NP's should not call themselves doctors.

創作這段視頻的人認為，非執業醫師不應該自稱為醫生。

How to Become a Nurse Practitioner Nursing has a separate training and organization

如何成為一名執業護士 護理工作有一個獨立的培訓和組織機構

structure compared to medicine. To become a physician, you attend medical school, residency,

與醫學相比，其結構更復雜。要成為一名醫生，你要上醫學院、住院醫師。

and test for board certification in a given specialty. In nursing, there are multiple

併為某一專業的委員會認證進行測試。在護理學中，有多個

types of advanced practice registered nurses. Nurse practitioners are what we're focusing

高級實踐註冊護士的類型。執業護士是我們所關注的

on, but there's also a certified registered nurse anesthetist, or CRNA, who provides anesthesia

但也有一名註冊麻醉師，即CRNA，提供麻醉。

services in the operating room and intubation in healthcare settings. Certified nurse midwives,

手術室中的服務和醫療機構中的插管。註冊護士助產士。

or CNM's, specialize in women's reproductive health and childbirth, and provide prenatal

CNM，專門研究婦女的生殖健康和分娩，並提供產前和產後護理。

and postpartum care and deliver babies. Clinical nurse specialists, or CNS's, focus on advanced

護理和產後護理，併為嬰兒接生。臨床護理專家，或稱CNS，專注於高級護理。

clinical knowledge and evidence-based nursing in a specific area.

在一個特定領域的臨床知識和循證護理。

There are two main pathways to become a nurse practitioner: traditional and direct entry.

成為執業護士有兩個主要途徑：傳統和直接進入。

The traditional pathway involves first earning your BSN, ABN, or MSN to become an RN after

傳統的途徑包括首先獲得你的BSN、ABN或MSN，然後成為一名護士。

taking your NCLEX exam. Most that take this pathway will work as an RN for a few years,

參加你的NCLEX考試。採取這種途徑的大多數人將作為護士工作數年。

although this is not required. Next, they attend a master's or doctorate program to

儘管這並不是必須的。接下來，他們參加一個碩士或博士課程，以便

become an NP. If you attend a full time master's program, it will generally take 2 years, but

成為一名國家護士。如果你參加全日制碩士課程，一般需要2年時間，但

if you are undergoing a part-time DNP program, it can take up to 5.

如果你正在接受非全日制的DNP課程，它可能需要長達5年的時間。

Choosing between a master's or doctorate program is not mission critical, as it doesn't change

在碩士或博士課程之間做出選擇並不是什麼關鍵任務，因為這並不改變

your practice, pay, or licensing exams. More programs are moving toward the doctorate program,

你的實踐，工資，或執照考試。更多的項目正在向博士項目邁進。

which, in comparison, is more focused on research and enables you to teach.

相比之下，它更專注於研究，並使你能夠進行教學。

The second pathway, or direct entry nurse practitioner programs, are for those who earned

第二種途徑，即直接進入護士執業計劃，是為那些獲得了

a bachelor's degree in something else. These are 3-5 year programs, where you will take

其他方面的學士學位。這些是3-5年的課程，你將參加

both the NCLEX to earn your RN but also complete a master's or doctorate program to become

既要通過NCLEX考試獲得註冊護士資格，又要完成碩士或博士課程，成為註冊護士。

an NP. Again, more programs are transitioning to the doctorate program, which is generally

執業醫師。同樣，更多的項目正在向博士項目過渡，這通常是指

longer by approximately 1 year. At the end of either path you choose, you'll

長約1年。在你選擇的任何一條道路結束時，你會

take your certification exam, which is the nurse practitioner board exam. It does vary

參加你的認證考試，也就是護士執照考試。它確實有所不同

based on your area of specialization. And after that, you can apply for licensing in

基於你的專業領域。而在這之後，你可以申請在

your state and find a job. In terms of cost, nurse practitioner tuition

你的州並找到一份工作。在費用方面，護士執業者的學費

costs are lower than PA or medical school paths. In-state tuition averages to about

費用比PA或醫學院的途徑低。州內的學費平均約為

$18,000 to complete a NP program, while out-of-state is around $32,000. Online programs are in

18,000美元完成NP課程，而州外的課程大約為32,000美元。在線課程是在

the middle, totaling around $22,500 for completion, while private universities are more expensive,

中間，完成學業的總費用約為22,500美元，而私立大學的費用更高。

around $45,000. Average compensation is around $110,000 per

約45,000美元。平均報酬約為110,000美元/年

year, but there is variation depending on the certification. Women's health are at the

年，但根據認證的不同，也有差異。婦女健康是在

bottom, around $98,000, whereas acute care NP's and psychiatric mental health NP's are

底部，大約98,000美元，而急症護理NP和精神病心理健康NP則是

at the top, around $114,000. What You'll Love About Being an NP

頂端是114,000美元左右。你會喜歡成為一名國家護士的原因

There's a lot to love about being a nurse practitioner. There's a favorable work/life

作為一名執業護士，有很多值得喜愛的地方。有一個有利的工作/生活

balance, usually without call. You'll also have varying levels of autonomy, where you

平衡，通常不需要打電話。你也會有不同程度的自主權，在這裡你可以

can be a provider making decisions, yet the training is not nearly as hardcore or as lengthy

可以成為一個做出決定的提供者，但培訓幾乎沒有那麼硬核或那麼長。

compared to that of a physician. NP training is shorter than becoming a physician,

與醫生相比。非執業醫師的培訓時間比成為醫生要短。

lasting generally 2 to 4 years compared to 4 years of medical school plus 3 to 7 years

一般持續2至4年，而醫學院為4年，加上3至7年。

of residency. The cost is much lower too, so you'll likely graduate with substantially

的居住地。費用也低得多，所以你畢業時可能會有大量的錢。

less debt than if you went the MD or DO route. As an NP, you also won't have to take work

比起你走醫學博士或醫學博士的路線，你的債務更少。作為一名國家護士，你也不必參加工作。

home with you or deal with things like overnight call — these are all factors that come with

與你一起回家或處理像通宵電話這樣的事情 - 這些都是伴隨著的因素。

the added responsibility of being a physician. And because you're not the person on the

作為一名醫生的額外責任。而且因為你不是那個在

line, there's less stress about malpractice or things going sideways, unless you're

在這條線上，關於不當行為或事情發生的壓力較小，除非你是

practicing independently. If you're ever unsure about something, there's often a supervising

獨立練習。如果你有什麼不確定的地方，通常會有一個監督者來幫助你。

physician to run things by. Most RN's don't get the opportunity to build

醫師來處理事情。大多數護士沒有機會建立

longitudinal relationships, but as an NP, particularly in a primary care role, this

縱向關係，但作為一個非營利組織，特別是在初級保健的角色，這

is the norm, and many find it highly gratifying. Hours are usually regular and predictable,

這是一種常態，許多人發現它非常令人滿意。工作時間通常是固定的和可預測的。

depending on your practice setting. While it depends on the specialty, you can expect

取決於你的執業環境。雖然這取決於專業，但你可以期望

to work around 40 hours per week. What You Won't Love About Being an NP

每週工作40小時左右。作為一名護士，你不會喜歡的事情

While being a nurse practitioner has its perks, it's certainly not for everyone.

雖然當護士有其好處，但肯定不是每個人都適合。

If you're interested in primary care, the NP route is great, but if you want to keep

如果你對初級保健感興趣，國家護士路線是很好的，但如果你想保持

your options more open and possibly consider something surgical, there tends to be more

你的選擇更加開放，並可能考慮一些手術，往往會有更多的

opportunities going the PA route. While the training is much shorter, you will

走PA路線的機會。雖然培訓時間短得多，但你將

also be making 1/2 to 1/3 of the average physician's salary. If you care about prestige and respect,

也會賺取普通醫生工資的1/2到1/3。如果你關心的是聲望和尊重。

which are not great reasons to base your future career off of, then the MD or DO route may

這些都不是你未來職業發展的很好的理由，那麼醫學博士或醫學博士路線可能是

satisfy that to a greater degree. On the other hand, if you're able to put your ego aside

在更大程度上滿足這一點。另一方面，如果你能夠把你的自我放在一邊

and understand your role on the team, including your responsibilities and scope of practice,

並瞭解你在團隊中的角色，包括你的責任和執業範圍。

this likely won't be an issue. If you want to have extensive knowledge of

這很可能不會是一個問題。如果你想擁有廣泛的知識

the human body and how to manage various ailments, the NP route will give you the foundations,

如果你想了解人體和如何處理各種疾病，國家執業醫師課程將為你打下基礎。

but it won't offer you the same level of training as going the physician route. You'll be able

但它不會為你提供與醫生路線相同的培訓水準。你將能夠

to handle the majority of bread and butter primary care, but when things get more complicated,

處理大多數的麵包和黃油初級保健，但當事情變得更加複雜時。

you may want to seek physician guidance. Between PA, NP, and physician, NP's usually

你可能想尋求醫生的指導。在PA、NP和醫生之間，NP的工作通常是

receive the fewest clinical hours, somewhere between 500 and 1,500 depending on the program.

接受最少的臨床時間，大約在500至1500小時之間，取決於該項目。

In comparison, PA's are required to have 2,000 clinical hours and physicians between 16,000

相比之下，助理醫師被要求有2000個臨床小時，醫生則在16000個小時之間。

and 20,000 at minimum. There's a tremendous deal of controversy over

和至少20,000人。有巨大的爭議，因為

the scope of practice for NP's. The American Association of Nurse Practitioners has been

NP的執業範圍。美國執業護士協會一直在

lobbying hard for increased scope of practice, meaning allowing nurse practitioners to provide

竭力遊說擴大執業範圍，即允許執業護士提供服務。

more care independently of physicians. After all, with greater scope comes greater autonomy

獨立於醫生的更多護理。畢竟，更大的範圍帶來更大的自主權

and compensation — but so does liability, as some are learning the hard way in malpractice

和賠償--但責任也是如此，正如一些人在不當行為中艱難地學到的那樣。

cases. YSK that if you are treated by a CRNA and

案件。YSK認為，如果你是由CRNA治療，並且

they make a mistake, they will not be held legally liable

他們犯了一個錯誤，他們將不會被追究法律責任

In a court ruling filed on June 16, 2020, an appellate court decided that "nurses are

在2020年6月16日提交的一份法院裁決中，一個上訴法院決定，"護士是

not supposed to be experts in the technique of diagnosis or the mechanics of treatment"

不應該是診斷技術或治療機制方面的專家"

even if they work as nurse practitioners or CRNAs. This ruling occurred after a CRNA made

即使他們作為執業護士或CRNA工作。這項裁決發生在一個CRNA提出

a completely avoidable mistake that led to the death of a 3-year-old child. Even after

一個完全可以避免的錯誤導致了一個3歲孩子的死亡。即使在

the death of the child, the CRNA was not punished and is still working in a hospital today.

在孩子死亡後，這位註冊護士沒有受到懲罰，至今仍在一家醫院工作。

Opponents to increased scope push back about the implications on patient safety. After

反對擴大範圍的人反駁了對病人安全的影響。在

residency, a physician has accrued approximately 20,000 or more hours of clinical experience

在住院期間，醫生已經積累了大約20,000個或更多小時的臨床經驗。

in their particular specialty. In comparison, a DNP only needs a fraction of that, between

在他們的特定專業中。相比之下，DNP只需要其中的一小部分。

500 to 1,500 hours of patient contact hours to graduate, which aren't necessarily focused

500至1,500小時的病人接觸時間才能畢業，這不一定是重點。

in their ultimate specialization. My NP colleagues tell me that those pushing for increased scope

在他們最終的專業領域。我的NP同事告訴我，那些推動擴大範圍的人

of practice are a vocal minority, but that most NP's don't share this mentality.

執業醫師是少數人，但大多數非執業醫師並沒有這種心態。

Don't get caught up in the online hype – this isn't about physicians versus nurse practitioners.

不要被網上的炒作所迷惑--這不是醫生與護士的問題。

The healthcare team needs to work together to serve the patient. When both groups of

醫療保健團隊需要一起工作，為病人服務。當兩組的

professionals work together and as intended within their scopes of practice, everyone,

專業人員在他們的業務範圍內共同工作，並按計劃進行，每個人都是如此。

including the patient, wins. In recent years, given the growth of diploma mills and online-only

包括病人在內，都是贏家。近年來，鑑於文憑製造廠和只在網上出售的文憑的增長

programs in conjunction with increasing scope of practice, there are growing concerns regarding

伴隨著執業範圍的擴大，人們越來越關注以下問題

patient safety. If you'd like to learn more about this issue, I recommend checking out

病人的安全。如果你想了解更多關於這個問題的資訊，我建議你查看

the Physicians for Patient Protection, an organization with great articles and presentations

醫生保護病人組織，該組織有很好的文章和演講。

about this subject, which go much deeper than I can cover in this video.

關於這個問題，它比我在這段視頻中所能涉及的要深得多。

Should You Become an NP? How can you decide if becoming a nurse practitioner

你應該成為一名初級保健醫生嗎？你如何決定是否成為一名執業護士？

is a good fit for you? If you enjoy being a team player, educating

是否適合你？如果你喜歡成為一個團隊成員，教育

patients, and making decisions regarding patient care, the NP route may be a good fit. Those

如果你是一個有經驗的醫生，並能對病人的護理作出決定，那麼國家執業醫師的路線可能是一個很好的選擇。那些

who may not like the patience or cost required for medical school will likely appreciate

可能不喜歡醫學院所需的耐心或費用的人可能會欣賞

the shorter and less costly option of going the NP route.

縮短時間和減少成本的選擇是走國家公園路線。

If you are currently on the nursing tract and want to go to the next level, consider

如果你目前在護理道上，並想更上一層樓，可以考慮

becoming an NP. If you prefer the medical model, then you may want to consider the PA

成為一名國家執業醫師。如果你喜歡醫療模式，那麼你可能要考慮PA

route instead. If you want more control, autonomy, and depth,

路線代替。如果你想要更多的控制權、自主權和深度。

knowing all the ins and outs of various diseases, including the obscure ones, and be at the

瞭解各種疾病的所有來龍去脈，包括不知名的疾病，並在

pinnacle of patient care and research, go to medical school and become a physician.

在病人護理和研究的巔峰，去醫學院學習併成為一名醫生。

These are all tradeoffs and there's no right or wrong here. No specific path is better

這些都是權衡的結果，在這裡沒有對錯之分。沒有特定的道路是更好的

or worse than another path. You have to figure out what type of life you want. Look at the

或比另一條路更糟。你必須弄清楚你想要什麼類型的生活。看一下

future paths of each, and see which is better suited to your personality, values, and long

的未來道路，看看哪種方式更適合你的個性、價值觀和長遠發展。

term desires. Big shout out to Nurse Liz, family nurse practitioner,

期的願望。向家庭護士Liz大喊一聲，她是家庭護士從業者。

for helping me in the creation of this video. Go show her some love and check out her YouTube

在這段視頻的創作過程中，我得到了她的幫助。去向她表示愛意，並查看她的YouTube

channel, link in the description. If you enjoyed this video, check out my video

頻道，鏈接在描述中。如果你喜歡這個視頻，請查看我的視頻

on So You Want to Be a PA, or my video comparing the competitiveness of PA school to NP school

關於《你想成為一名助理醫師》，或我的視頻，比較了助理醫師學校和非執業醫師學校的競爭力

to medical school. Much love, and I'll see you guys there.

到醫學院學習。非常感謝，我們會在那裡見到你們。