[edit at 1109 7/15/06 est per request of mod. i have kept the citations intact in hopes that some readers will take the time to look at these articles. if this is inadequate or continues to violate the tos i would appreciate being informed. thank you.]
ok. we are pretty far afield of the thread title and thrust of my position, but here goes.
this study has been cited so many times on this and evry other nursing site it now is in real time syndication right after golden girls at 11.
that said, it was an eye opener...at the time. this article opened a needed door into a the world of more efficient practice management utilizing a great resource, the np.
welcomed by many docs, it ran fairly roughshod over many issues in the debate. let's first look at the disparity in n. the np arm was significantly larger. with greater power, one could assume this would skew the data.
this study was performed in an arena of physician oversight. these nps could default at any time if patient needs fell out of their expertise. this is mightily different from the proposals we see today.
let us also note that these were the old school of nps. these are the folks who made the possibility of today's profession. multiple years of clinical experience preceding their graduate programs. they were not five semester widgets churned out after their arduous training in english comp, medieval studies or theology. (btw-two of those degrees are held by the s.o. of the best man at my wedding. she is an np)
beyond design/reporting flaws, it was written in a different time for a different audience. the study took place 1995-1997. how many of us considered a future where the promotion of the np would lead to an attempted physician equivalence. noting the authors and their institution i think we can recognize a few who saw a zany and scary future.
see study below and my bold face above
i cannot respond to anything posted from cna. it is a rabidly anti physician site. its position statements are so far outside the sane nursing realm that it defines the lunacy of the dnp debate.
1. this position is one of support for the rational model of midlevel with physician supervision. yay.
2. it is from 1992. once again, today the aacn has attempted to remake the world in its image.
so here are a few of my own. i sincerely apologize for the c&p but my school's portal doesn't allow external links. i alaso happen to be weary and lazy.
apology #2-a large number of articles regarding the np debate are from the uk. who knew?
the evolution of the nursepractitioner
senior lecturer, school of nursing and midwifery, university of hertfordshire, uk
evidence-based healthcare management
nursepractitioners do not reduce general practitioners’ workload
brenda leese, bsc (hons) dphil, commentary author
reader in primary care research, centre for research in primary care, university of leeds, leedsuk.
☆ abstracted from: laurant mgh, hermens rpmg, braspenning jcc, et al. impact of nursepractitioners on workload of general practitioners: randomised controlled trial. bmj 2004; 328: 927–930.
now some real evidence.
as nurses we see the effects of overprescription of antibiotics. the consequences of non-indicated/overprescription of these agents is heavily documented. further, if you have worked in a hospital in the last 5 years you know what c. diff. colitis smell/sounds/tastes? like. 'nuf said.
wouldn't you expect the well trained, holistic practitioner to not fall into the script trap?
differences in antibiotic prescribing among physicians, residents, and nonphysician clinicians.
roumie cl - am j med - 01-jun-2005; 118(6): 641-8
from nih/nlm medline
nlm citation id:
am j med. 2006 may;119(5):e21-2; author reply e23-4
pubmed id: 16651040