An article appeared today in the New York Times as a followup to a bill passed in New York granting nurse practitioners the right to provide primary care without the oversight of a physician. The authors of the bill state "mandatory collaboration with a physician no longer serves a clinical purpose and reduces much-needed access to primary care". The need for more primary care providers is due to the shortage of primary-care physicians, the aging boomer population, and the Affordable Care Act.
Although the president of the American Association of Nurse Practitioners feels that the current "hierarchical, physician-centric structure" is not necessary, many physicians disagree citing that the clinical importance of the physician's expertise is being underestimated and that the cost-effectiveness of nurse practitioners is being over-estimated.
Many physicians also feel that "nurse practitioners are worthy professionals and are absolutely essential to patient care. But they are not doctors."
What are your thoughts on this? Where do nurse practitioners fit into the healthcare hierarchy?
I doubt many think you have exposed anything other than a lack of understanding of science or the extant data.
Edit: "the scientific method"
Haha, again, I have argued nothing nor made any claims having to do with the science or extant data (on primary care data, I can only presume you mean with this overtly broad accusation). I've only applied the same demands for evidence that wtbcrna has placed on others. I've stated this several times, you're either not reading, not understanding, or intentionally trying to distort my position.
So how does one remain natural in the setting of consistent repeated statistically significant data unless they are biased?
I do not claim to have examined all the data. Surely you're not implying that just because I'm told the data exists that I should choose a position, are you?
Haha, again, I have argued nothing nor made any claims having to do with the science or extant data (on primary care data, I can only presume you mean with this overtly broad accusation). I've only applied the same demands for evidence that wtbcrna has placed on others. I've stated this several times, you're either not reading, not understanding, or intentionally trying to distort my position.
You accuse everyone else of a lack of reading comprehension yet you fail to comprehend to basic principles:
1.) the original topic
2.) the scientific process in disproving equality, to be clear, the null in a study on the introductions in the clinical setting would be all provider introduce themselves with appropriate credentials. Data is needed to reject that.
I do not claim to have examined all the data. Surely you're not implying that just because I'm told the data exists that I should choose a position, are you?
Absolutely not. I would expect before posting on the topic one would examine the data.
You accuse everyone else of a lack of reading comprehension yet you fail to comprehend to basic principles:
1.) the original topic
2.) the scientific process in disproving equality, to be clear, the null in a study on the introductions in the clinical setting would be all provider introduce themselves with appropriate credentials. Data is needed to reject that.
The basic principles? Of what exactly? Your agenda?
1)
This is irrelevant to my issue with wtbcrna, I quoted a claim he made and demanded evidence for that claim. You can't escape this by claiming there's an "original topic", it's immaterial.
2)
No, if you had followed the chronological order you would have seen that the null for the other side of this particular argument was that Nurses confuse patients by introducing themselves as "Doctor Smith". The alternative hypothesis was "No they don't, because they introduce themselves as Doctor Smith, I'm your Nurse". You're making the false assumption that Nulls are objective and don't depend on the subject making the null. You made the null as it fit your case in this instance, anyone can do that. Therefore the null can be quite subjective. Your point 2) is patently false.
Data was not used to reject the Null, which has been my point of contention in the last several posts.
Absolutely not. I would expect before posting on the topic one would examine the data.
I would expect that as well, my guess is that no one here has actually examined all the data critically before choosing their positions. That's not what this is about, you know it and I know it. It's about vested interests.
This reminds me of all of the drugs that went through extensive testing/research/trials and were once proven to be safe and effective, and are now pulled from the market.
I know this isn't popular opinion, but I find it worrisome that someone can come out of an NP program without any prior RN hospital experience, and begin practicing independently. Never mind the 600 or whatever clinical hours required during school- even if "specializing from the beginning."
I worked with a tech that went on to become an RN, and then an NP- with a conscious decision she never wanted to work the floor as a staff RN- and subsequently-never knew what she didn't know.
It was truly frightening to witness this.
Another RN I once worked with- worked as an RN in the hospital for 20 or so years, and then became an NP, and as he was graduating and going to start working in a clinic, commented that he realized that he had so much to learn and expressed quite clearly that he was terrified to begin practice in the clinic (not even practicing independently).
I've worked with some really good NPs, but it seems a lot of them have either A. had 20-30 years of experience in a speciality area- such as SCN, and wouldn't even want independent practice, or B. Worked in the hospital for years as an RN - prior to becoming an NP.
There is even a recent debate here for profit NP vs not for profit NP schools here.
I feel if you want to practice independently an NP, things need to be more standardized: Standardized curricula with less theory/leadership fill in courses, and more math/ hard science. You must have a minimum of 3-5 years of RN experience in the hospital- ICU, etc..., , prior to admission into the NP/DNP program, and complete a minimum of 1-2 years of residency s/p completion of the same basic practice exam as required of the residents.
It's even more worrisome that some of the views expressed here seem to be NP/DNP=MD.
https://www.ncsbn.org/4213.htm The consensus model for APN education and licensure has been out since 2006 now and it is tentatively scheduled to be fully implemented in all states in 2015.
It is hard to judge if prior nursing experience helps or hurts NPs. To my knowledge there are no studies that show x amount of prior nursing experience help as APN.
I do know that after approximately 5 years of being out of school nurse anesthesia students have been shown to do worse during training and on boards. I suspect that would be similar for any graduate student.
We can all throw out numbers of what we think the minimum required experience should be for entrance into NP school, but without some kind of research to show it should be that. Very few schools or governing bodies are likely to make any changes in the minimum entrance requirements.
I support changing the minimum time for critical care experience for nurse anesthesia students, but since every study that has been done so far shows no positive difference in years of experience prior to NA school entrance requirements are unlikely to change despite numerous anecdotal accounts from CRNAs.
You may not have been serious about wanting to see those studies but you were serious in thinking you had made a reasonable response to my demands for evidence. However you unfortunately do not understand the difference between the two requests for evidence, namely one is demanding proof for the position taken by the poster I quoted, the same kind of proof he insists on demanding from others, the other is the logical fallacy of asking someone to prove a negative.
I was serious. The poster needs to be consistent and provide the same level of evidence for his claims as he demands of everyone else. If he can't do that, then he's being a hypocrite.
I'm struggling to even follow your criticism as I don't know of too many claims that I've made here that require or for which scientific evidence is even relevant. It's as though most of you here don't understand what you are asking for or why, you're merely trying to play a trump card or sorts, albeit poorly played and nonsensical.
It's almost as if you really don't know the difference between opinion and fact.
Opinions based on personal experience: how DNPs introduce themselves.
Fact: MD's and med students have ZERO scientific evidence to support continued requirements of supervision or beliefs about NP safety.
Why would anyone do "studies" on a topic as superfluous as introductions? Not to mention the relative newness of the DNP vs NP.
Especially when their are important things to study... Like how NPs compare to MDs in primary care.
Also, it would take very little stretch of imagination to conclude that you would reject out of hand any real critical examination of the literature on the subject. You seem to be under the quite naive impression that studies are objective and the data they produce stands on its own without a subjective analysis, interpretation, and conclusion.
Again this is your opinion without any scientific evidence to back it up at all. The data on NP outcomes when compared to physicians is overwhelming and has been examined and critiqued thoroughly. Just because you are unable to admit that the studies are accurate even when published by JAMA and done by physicians does not make those studies any less valid.
I would say that since your only purpose on here seems to be to argue without providing any meaningful dialogue that makes you a internet troll though.
I see you've yet again, evaded and redirected to a different issue. I'll take it that your final position is one of admitting you do not have any evidence, what so ever, to back your claim that I've quoted and been referring to over the span of several posts. In effect, you are hypocritically placing demands on others that you are not willing to fulfill yourself, as I suspected all along. For the sake of the audience, I think I've exposed you for the phony that you are and will drop this particular issue with you.
I would take that to mean you are a internet troll that is too uneducated to provide any scientific evidence to back up any of your claims.
Again where is any scientific proof to any of your claims about NPs?
BostonFNP, APRN
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So how does one remain natural in the setting of consistent repeated statistically significant data unless they are biased?