debate concerning if it was better to become a Physician's Assistant, or Advanced Practice Nurse. Those who advocated the PA path referenced the fact that many MD's preferred working with PA's who were trained in the "medical school" model of patient accessment rather than the "nursing school
" model. What are the salient points of departure between these "models" of patient accessment? Furthermore, what are the supposed advantages and liabilities of each approach?I have been unable to find hardly any relevant information expanding upon this topic.
Aug 17, '02
it is grounded upon this thesis. All "medical service providers" whether they be doctors, nurses, radiographers or labratory technicians exist primarily to serve their customer which is ultimately the patient. Therefore, ALL practices should be determined based upon how that can best be accomplished. In some circumstances objective research as to the best approach is difficult. However, with regard to patient accessment and certain other issues (I remember for instance reading a debate several years ago concerning the relative efficacy between several cardiac "clot buster" medications, I think they were streptokinase and TPA. Research eventually indicated that both were equally effective however the streptokinase was much cheaper) the scientific method should be more than capable of elucidating the "statistically best" approach with regard to patient outcomes.
Indeed, part of my curiosity with regard to this issue emanated from my desire to learn IF the poster was in fact expressing a sincere concern (that is to say if he/she was REALLY interested in differential patient accessment approaches practiced by AP nurses and PA) or instead used this criticism to veil their other actual concerns (such as the ones you mentioned).
To the extent that nurses differ from other health professionals (such as PA's) in the administration of health services we should be able to defend those practices with research that validates our approach. Nursing theory if fine so long as like any theory it continues to be supported by research and experimentation. Furthermore, one must exercise care that long held theories or practices do not degenerate into unquestioned dogmas.
Last edit by Roland on Aug 17, '02
Aug 18, '02
1. Physicians are generally not "being sincere." The fact is (as already mentioned) that a licensed PA still cannot practice unless under the direct supervision of a physician. Nurses, on the other hand, can hold a nursing license, and can practice nursing, without "benefit" of a physician. Hence, PA's are under the thumb of physicians, and cannot generally disagree with physicians. Nurses, on the other hand, practice independently of physicians, and their jobs (usually) do not depend on the good will of the physician. This simple fact has been a burr under the blanket of the AMA for years. Simply stated, most physicians want everyone in the health care community to be "under" them. Many long for the return of the day when nurses stood up when physicians entered the room. So, the question is flawed. The statement "Physicians prefer working with PA's trained in the medical school model of patient accessment instead of AP nurses trained in the nursing school model." may be better restated "Physicians prefer working with PA's whose licenses depend on physicians, and are therefore subservient to physicians, over nurses, who have independent licenses, and are therefore not under the physician's thumb."
2. Igvc and I are in agreement where nursing theory is concerned. Most nursing theory is merely an academically reworded statement of the obvious. The one glaring exception is Roger's theory of unitary human beings. This "theory" was obviously conceived while stoned on hash, and fleshed out in full at the height of an LSD trip. At best, it is more a metaphysical treatise rather than a scientific theory. That's the problem with many "nurse scientists." They cannot tell the difference between religious belief and solid scientific theory.
Feel free to flame.
Kevin McHugh, CRNA
Last edit by kmchugh on Aug 18, '02