hvert,
I would have put your boyfriend on doxycycline. And I wouldn't have charged $200! Yikes.

Let me see if I can clarify a few things.

One of the problem is that nursing encompasses such a wide range of skill sets and educational levels. Some people call medical assistants "nurses" (they are not); and the field has a spectrum from vocational or practical nurses to PhDs and post-docs.

Registered Nurses
In the United States, one can practice in all states except South Dakota with an associate's degree. Due to prerequisites, it's usually a bit longer than two years.

Although there is strong research to support mandatory bachelors degrees, there are too few nurses and a massive shortage of nursing faculty. So it would paralyse the system to require a bachelor's degree.

Both associates degree and bachelor's degree RNs take the same licensure examination.

Nurse Practitioners
There are a handful of NPs in certain states who only earned a "certificate." This is legal in some states, but quite rare. Those NPs with certificates rather than masters degrees may have trouble getting privileges, credentials, etc. But we're talking about a very small population of NPs.

The majority of NPs are now educated as post-bachelor's students. Students earn a bachelor's degree, meet a range of basic science prerequisite courses, and take the GRE. The masters degree includes an accelerated RN component (the hours of clinical experience and course work are the same as a bachelor's degree in nursing to meet state requirements.) The remainder of the programme is spent learning to be an NP.

Although the initial goal was 2015, the doctoral requirement will take longer. . Again, the shortage of faculty and need for more NPs to be in practice has curtailed this effort. NPs have decades of research to show that they practice safely and effectively at the masters level. But a doctorate is still a good idea. There are also some dicey doctoral programs, but there are dicey medical schools and residency programmes too.

NPs must take the RN licensure exam. And then all NPs (masters or doctorate level) must take a national certification examination that is specific to an area of practice (family practice, paediatrics, neonatology, etc.)

NPs do not have "residencies" in all states (there are many terms used for this.) There are varying levels of supervision for new graduates. Some of this is state-regulated; some is self-regulated.

Regardless of the state, an NP practises under his or her own license.

What are the things that NPs cannot do compared with a physician?
A common question but almost impossible to answer. NPs and physicians all vary in their own expertise, comfort level, education, and practise environments.

Some states have arcane laws that limit NPs. These are slowly fading. And the research strongly supports removing these restrictions: these laws can inhibit access to care, increase costs, and actually increase malpractice risk.

Shouldn't a 'real doctor' be right there in case the NP doesn't know what he or she is doing?
ALL healthcare providers, regardless of professional designation, have a responsibility to know their limits. A physician can easily get in well over his or her head, and has a responsibility to consult. The same applies for NPs. The best clinicians collaborate in person, on the phone, in conferences, etc.

Although "teams" are in vogue right now, it's not necessary. I do not believe that you need a team of five people; but I think that it's always favourable to have a minimum of two clinicians in a practice (who like each other.) It doesn't matter if they're NPs, physicians, or any combination thereof.

Should I see the 'real doctor' intermittently to make sure that the NP isn't screwing up?
If you think that an NP is incompetent, you shouldn't be seeing him or her at all! I strongly support continuity of care and patient preference. See the provider who makes you feel comfortable, spends time with you, and helps you feel well.

Unless someone is a resident or a new graduate, be sceptical of a practise that requires you to switch around between providers. You deserve one person you can trust.

What do I call a nurse practitioner?
I got this question a lot. Since I predominantly saw young people, I was called "Dr." (and I have a doctorate, so that's both polite and correct.) But I preferred to be on a first-name basis with older patients. A smooth NP will ask you how you would like to be addressed, and then you can figure it out from there.

In a few states (Ohio and Maine come to mind), NPs cannot use the title "doctor." It's okay for chiropractors, optometrists, naturopaths, podiatrists, psychologists, dentists, just not NPs. It's distasteful because it discriminates against a particular profession. Do these people want to read my dissertation? Do they know how long it took? Or the $350,000 in tuition? (Sorry, chip on my shoulder.)

Why don't NPs go to 'real' medical school?
Advance practice nursing has a lot of appeal. There is a strong focus on prevention, patient education, and empowering patients to make decisions about their own health. There is a philosophical difference that draws many of us to the profession.

It has become exceptionally difficult to get in to NP programmes: they're small and there is a faculty shortage. So--just like med school--many prospective NPs apply for a couple of years before they are accepted to a programme.

What is the difference between nurse practitioners and physician assistants?
Since I'm not a PA, I don't want to speak for them. The biggest difference is that a PA is--by definition--an assistant or associate to a physician. The PA is tied to a physician and to the physician's license. A nurse practitioner is an autonomous healthcare provider.

PAs are educated under a strictly medical model whereas NPs are educated as nurses first, then as PAs. Although there are still some "certificate" PAs, most are educated with masters degrees.

Unlike NPs, PAs take a single licensure exam. Their license is general and versatile. NPs are licensed in particular areas of practice (neonatology, psychiatry/mental health, women's health, acute care, etc.)

Do they have nurse practitioners in countries other than the USA?
Yes. The UK, Canada, New Zealand, Australia, Israel, and the Netherlands all have established NPs. Although Canada is changing, the other countries have very strict limits. Most of the programmes are at the "certificate" level, not the masters or doctoral level. And the scope of practice is severely limited compared with the USA. Outside of the US, there is demand for NPs, but the educational and healthcare infrastructure are not yet in place.

I firmly believe that you can see an NP, PA, or physician and have good, bad, or mediocre experiences with any of them. Look for the right person, not the initials after his or her name. It may take some trial and error, but you're better off finding someone who will partner with you, and keep you at ease.