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?
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.
Yet, you still cannot provide any scientific evidence just meaningless dialogue.
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.
It's as if you don't understand what context means.
You've all followed the same trajectory to try and defend your colleague, I can appreciate that to a degree but come on...You're only fooling yourselves. You've all tried to imply that my statements to him about his personal demands on everyone else to prove their opinions with scientific evidence (which is so ridiculous that none of you will let me get away with it, but don't say a word when he did it multiple times), are making me out to be saying something one way or the other on this whole NP vs MD issue. Which I haven't, and the fact that there is zero evidence that I have, is the most telling of all things in this conversation.
You're paying lip service to the scientific method, but your critical thinking, reading, and reasoning is ultimately driven by your agenda, bias, and loyalties.
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.
Nice try.
I know lots of Doctorate prepared nurses and I also know how they present themselves professionally. Can you say the same thing?
Trying to divert the subject won't work here. You have provided no scientific evidence in any of your posts on NP independent practice, so would you care to provide any scientific evidence or just continue with meaningless dialogue?
It's as if you don't understand what context means.
You've all followed the same trajectory to try and defend your colleague, I can appreciate that to a degree but come on...You're only fooling yourselves. You've all tried to imply that my statements to him about his personal demands on everyone else to prove their opinions with scientific evidence (which is so ridiculous that none of you will let me get away with it, but don't say a word when he did it multiple times), are making me out to be saying something one way or the other on this whole NP vs MD issue. Which I haven't, and the fact that there is zero evidence that I have, is the most telling of all things in this conversation.
You're paying lip service to the scientific method, but your critical thinking, reading, and reasoning is ultimately driven by your agenda, bias, and loyalties.
My work here is done.
Yes, I would say your work here is done, if that work was to prove that you cannot critically read research and are unable to provide any scientific evidence to support that NPs shouldn't work independently.
So in the qualification of providing effective primary care, show me a study that demonstrates NP does not equal MD/DO.
And the truth comes out.
so you believe (because of a few studies) that NP = MD/DO but only in practice, not for licensing or malpractice... But you don't want to be physicians... Is anyone else confused?
Quite the contrary. I would be more than happy to consider any major (or minor) study that refuted the dozen studies that have reported consistent results. Please, cite a link to any such critical examination.
There is no naivety here. There is, however, a substantial body of supporting literature published in a myriad if countries and peer-reviewed journals. Unless you honestly think we are taking about an international and multidisciplinary conspiracy....
myriad of countries? Can you provide 4 other countries that have APN...
so you believe (because of a few studies) that NP = MD/DO but only in practice, not for licensing or malpractice... But you don't want to be physicians... Is anyone else confused?
When you let them talk, they always reveal what is behind their agenda... I want to get a piece of the pie, but I am not willing to do the work for it.
Poking my head back in for a minute... I mentioned working w/ lots of them some pages back. Actually one of the STAFF physicians--not residents--on my hospital's neurosurgery service holds an MBBS. She signs her notes as Firstname Lastname, MBBS. I work in a level 1 trauma center, so the neurosurgery service is pretty vital. Personally I would trust her or any of our other neurosurgeons w/ my or my family's life, were we to need trauma care.
I do not understand how someone can cram that much in 4 yrs.
Sorry,but i would not trust any physician with a 4 yr degree.
wtbcrna, MSN, DNP, CRNA
5,128 Posts
Yet, you still cannot provide any scientific evidence just meaningless dialogue.