Flying scalpels and the future of health care

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Have you ever seen a physician throw anything?

  • Yes, a scalpel

    Votes: 7 11.5%
  • Yes, an object, but not a scalpel

    Votes: 11 18.0%
  • No

    Votes: 43 70.5%

  • Total voters
    61
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I wish i could get every np in a room and teach them how to actually evaluate medical research. Then we wouldn't have these tired and stupid talking points trotted out over and over again with the smugness of an atheist debunking the bible

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oh dear, james....rape culture? "girl" means rape culture?
 
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Even though you're obviously trolling, I feel compelled to answer.

First, pretty sure they only accept adults into the NP program, not "girls." What century are you living in, dude?

http://lmgtfy.com/?q=Define+girl

And "in school for a total of 4 years," meaning 4 years of elementary school, high school or something else? I have no idea where you get your information. Most nurses start their professional training in their undergraduate educations, 2 years of sciences and liberal arts following by 2 years of nursing. It used to be NPs would then go on to graduate school for another 2 years, but now they go to graduate school for 4 years for a DNP. This makes 6 years of education in their profession compared to our 4.

My wife has a BSN and has been a peds heme/onc nurse for 5 years. I was an OR tech for 7.5 and worked with many NPs, RNFAs, and PAs. I'm friends with several NPs, PAs, and CRNAs. Also, I know how to use Google to find program information. That's where I get my information.

I worked with tons of RNs who did the year of prereqs and then went straight to nursing school. So assuming she does that, then gets her BSN, which you can do in one year (online at many programs), followed by an 18-month FNP program (which not only seem to be standard, but also exist as online programs--talk about scary), she'll have been in school for a total of 5.5 years with only very basic science courses and a lot of nursing theory courses. And yet she'll have prescribing and independent practice rights.

Most NPs do not get a DNP to practice. I don't know a single practicing NP that has or wants one (not evidence, I know, but still).

That's why you should watch your contempt.

Nowhere in my post did I express contempt. I simply stated facts.

And they get a lot of practice in between their undergrad and graduate educations in general, which gives them a more solid base to build their graduate educations on. I doubt they would mind residencies, but they don't get the same funding for their residencies that we do.

Unless they go straight through, which is an option because many programs do not require clinical practice. My issue was not with NPs who have clinical experience. It was with providers who have little to no clinical experience and a not-at-all comprehensive "medical" education, particularly when they have bad and condescending attitudes.
 
Really, you're going to tell me what's culturally appropriate based on some outdated, stodgy dictionary?

http://everydayfeminism.com/2015/06/grown-women-are-not-girls/
Calling Grown Women ‘Girls’ Is Sexist As Hell – Here Are 4 Reasons Why
June 30, 2015 by Carmen Rios

I landed my first feminist internship when I was a freshman in college. And it was there that I made a very frequent mistake: In writing about situations involving grown women, I would repeatedly call them “girls.”

It didn’t take long for me to be informed that it was unacceptable, especially in writing and particularly news writing, to refer to adults as “boys” or “girls.” This seems like common sense now, although actually putting it into practice can still be hard for me.

And that’s because saying “girl(s)” comes naturally to me, as it does to so many of us. But just like calling groups of people “guys” is a widespread and completely normalized practice that inadvertently minimizes the existence of women, so does calling groups of people “girls.”

And yet, unlike using “guys” as a third-person plural catchall, the use of the word “girls” to refer to women is very rarely called out on as sexist. In fact, it still goes largely unnoticed, even by people who should “know better.”

Even I’m still guilty of calling women “girls.” Even though I know I shouldn’t, the word still finds its way to the tip of my tongue. And I hear it everywhere in my circles, too.

People, including me, go out with “the girls,” identify themselves and their friends to the world as “girls,” and talk generally about women’s issues by talking about the lives of “girls,” even when they mean “women.”

Even media with feminist leanings use “girls” as a catchall for adult topics or stories about adult women.

Think of shows like Girlfriends, New Girl, Gilmore Girls, and even Lena Dunham’s own Girls. Ormovies like Girl with the Dragon Tattoo; Girl, Interrupted; and Dream Girls. Even the book Girlboss is guilty of it.

That’s because calling women “girls” is commonplace, and most people don’t bat an eyelash when they do it or when they hear someone else doing it.

In fact, calling women “girls” is so normal that people actually feel uncomfortable calling them “women” instead.

Countless think pieces chronicle an author’s journey to decide when one is not a girl or, conversely, not yet a woman. Feminists and non-feminists alike have documented their own attempts to nix the phrase completely, often, in the process, realizing how weird it feels to call the adult ladyfolks in their lives “women.”

But here’s the thing: Calling a woman a “girl” isn’t okay.

When we call women “girls,” we’re using the force of language to make them smaller. We resist and deny their maturity, their adulthood, and their true power.

When you call a woman a “girl,” you’re actually saying a lot of very serious things about gender politics and womanhood.

This is a call to action. We need to actually start using “women” when that’s what we mean. Because when we refer to women as “girls,” this is what we’re doing.

1. When We Call Women ‘Girls,’ We’re Infantilizing Them
The textbook definition of a “girl” is a female-identified person under the age of 18.

In that way, the term refers to children. And using it to talk about adult females – women – infers that women are, in some way, still immature or childish.

In that way, calling women “girls” (very actively) infantilizes them.

The infantilization of women occurs across realms, especially in American culture.

Advertisements and other forms of media portray women as being childlike and immature. People of all genders are socialized to see women as helpless, irrational, weak, and in need of protection, and legislators feel it’s okay to tell women how to run their lives and what to do with their bodies. We handle women with “kid gloves,” as if their emotions are going to make them incapable of rational behavior in times of stress or conflict.

Of course, our shared cultural tendency to refer to adult women as “girls” isn’t the only example of our culture’s infantilization of women or obsession with women’s youthfulness.

We live in a society where women’s bodies are only seen as attractive, desirable, and – thus, because of the patriarchy – worthy and valid when they fit an ideal standard of beauty. That standard is undeniably sexist. But it’s also racist, ableist, cissexist, heteronormative – and ageist.

Women are only seen as beautiful when they’re young – and a huge amount of pressure is put on women to look, act, and seem young for as long as possible.

As women age, they also see less of themselves reflected in the world around them. They’re less likely to encounter stories similar to their own in books, movies, or television shows. Advertisements rarely apply to them, unless they’re for anti-aging products. And the women they do see who are their age are being praised for “not looking” it.

As our culture demands women stay young forever in order to retain their socially constructed sexual attractiveness (and thus, usefulness to the patriarchy), it also sexualizes young women and girls – and the adult women who look like they’re under 18.

American Apparel came under fire over and over again for producing advertisements that sexualized either adult women who appeared to be underage or actual minors.

Adult actresses are routinely asked to play characters who are younger than they are (and even minors!), which results in a skewed media portrayal of young womanhood. And as a result, actual girls – who are under 18 and not legal adults – are seen as sexually desirable and available.

And thus…

2. When We Call Women ‘Girls,’ We Perpetuate Rape Culture
The end result of all that infantalization and sexualization?

Our society’s obsession with women looking, acting, and being young has fueled a rape culture that victimizes young women and girls.

Here’s what that looks like:

Older women are told they’re not desirable, and advertisers coax them into doing all they can to preserve their youth and vitality. Meanwhile, younger women and girls are bombarded with messages that tell them their worth is measured via their sexuality.

An APA study in 2010 found that young women and girls are sexualized rampantly in our culture. The study defined “sexualization” as occurring when:

a person’s value comes only from his or her sexual appeal or behavior, to the exclusion of other characteristics;

a person is held to a standard that equates physical attractiveness (narrowly defined) with being sexy;

a person is sexually objectified – that is, made into a thing for others’ sexual use, rather than seen as a person with the capacity for independent action and decision making; and/or

sexuality is inappropriately imposed upon a person

Sound familiar?

I know it does.

Because it’s rape culture.

And that same rape culture also infantilizes adult women (as well as young women and girls) by denying them their sexual agency. Survivors of sexual assault are questioned, and they’re overwhelmingly not believed. They’re seen as irrational and perceived to be devious and untruthful.

When we call women “girls,” we’re playing in to all of that.

We’re feeding the double-standard that says grown men are sexy into their 60s, while women are best appreciated when they’re close to 18 (“barely legal,” anyone?).

We’re perpetuating a norm in which being a “woman” means the end of being desirable and the beginning of the slow death of someone’s societal worth.

By reclaiming the word “woman,” and using it to refer to grown-ass adults as we should, we fight back against the infantilization of women. And when we do, we cut short a rape culture that sexualizes actual girls at the same time.

3. When We Call Women ‘Girls,’ We’re Disrespecting Them
Despite what appears to be a widespread discomfort with the term “women,” folks don’t seem to be uncomfortable disrespecting women by referring to them en masse as children.

We don’t seem to realize that “girl” is a diminutive term or to think critically about the ways in which perceiving of women as “girls” disrespects them.

Our society regularly discredits women, often because they’re perceived as immature, incapable, or otherwise less than their adult male peers.

That’s because, for the most part, our culture sees women the same way they see actual girls: weak, frivolous, dependent, foolish, irrational, impulsive, and impetuous.

When we call women “girls,” we conflate them with their younger counterparts in the turn of a phrase. We’re indicating that they are more alike to children than to adults.

And that’s incredibly disrespectful, not to mention disempowering.

Calling women “girls” plays into a sexist culture that refuses to see women as whole, independent people with valid feelings, thoughts, and opinions.

When we call women “girls,” we make it easier for their bosses to dismiss their suggestions or look them over when it’s time to promote folks to leadership positions. When we call women “girls,” we fuel an academic system that sees women’s philosophical and intellectual pursuits as meaningless. When we call women “girls,” we make it easier for people to assume they lack strength, capability, and competency.

When we call women “girls,” we communicate that we don’t see a huge difference in the minds or behaviors of women and girls. Instead, we insist that women, of all ages, are childlike and immature.

We don’t do that for men.

We don’t call men “boys” on the regular, and that’s because we see men as adults – as authority figures in their own lives as well as the lives of others, as wise, as rational.

That empowers men to take risks, innovate, and go their own way. It also bestows upon them the male privilege of being assumed to have expertise, skills, and knowledge that we wouldn’t assume boys have, because they’re kids.

As a culture, we refuse to envision the same growth for girls who become women.

That’s why calling women “girls” is so problematic – it hinders women’s abilities to really see themselves as leaders, thinkers, and doers.

Women are already swimming in a sea of male privilege and entitlement. They’re surrounded by and often part of male-dominated institutions in what is undeniably a male-dominated society.

Being seen as on par with their male peers – and using equivalent terms to address and categorize them as we do men – can empower women to really tap into their potential and push other folks to take them seriously.

4. When We Call Women ‘Girls,’ We’re Not Taking Them Seriously
We don’t take kids seriously.

We care deeply about their well-being and personal growth and we listen closely as they articulate their own needs – or at least we should – but we don’t take them seriously.

We don’t trust them with major decisions about finances and lifestyle choices; we don’t task them with complex and meaningful work; and we don’t expect them to be self-sufficient or entirely responsible.

We don’t treat men the way we treat boys – and we shouldn’t. Because we shouldn’t treat adults the way we treat children.

But often, we don’t take women seriously enough to do the same for them. Often, we treat women like children by disregarding their voices, experiences, and ideas altogether.

For example, their political demands aren’t often taken up, despite the fact that women represent a majority of the voting population and consistently turn out well for elections.

Women have fought political battles for the right to do what they will with their own bodies, pursue the same leadership opportunities as men, and end some of the tragic circumstances of their own lives like violence and the feminization of poverty.

But legislators and the general public alike have spoken over them, insisted they know better, and sometimes even insisted they were limiting women’s options for their own good.

Further, their ideas and suggestions are ignored, mocked, or silenced – and sometimes, credit for those ideas and suggestions are even stolen.

Women throughout history have had their contributions to science, math, philosophy, and politics rendered invisible by sheer ignorance or blatant misinformation. They’ve been effectively cut out and pushed out of positions of power through which they could spark change. They’ve had their ideas shot down, laughed out, and robbed from them by men in positions of power.

And their own needs and experiences are mansplained back to them, dismissed as excessive, or straight-up unacknowledged.

When women explain how they’re feeling, they get gaslighted: Other people tell them they’re “just imagining it,” or that they’re “crazy” (which is hella problematic in and of itself).

People try to explain away their realities and challenge their own intuitive sense of self. Women who speak up demanding to live free from violence, discrimination, and harassment are told they’re asking for “special treatment.” And often, women who claim to have experienced violence, discrimination, and harassment aren’t believed.

And these examples may feel unrelated, but the truth of the matter is that this huge system that consistently puts women at a disadvantage (uhh, we call that “patriarchy”) works both in major and minute ways.

And when we call women “girls,” we’re feeding into the same machine that reminds them constantly that we don’t take them seriously.

And that means they don’t matter.

***

Because our society diminishes women and their contributions, they’ve remained largely invisible in our history. We erase them, or rewrite their stories, or tell their stories without ever saying their names.

And we do this to reduce them so as to make them take up less space and garner less recognition. We do it to make them smaller. Like girls.

But women deserve space. Women deserve recognition. Women deserve to contribute.

Women deserve to be perceived as capable, intelligent, independent, freethinking, rational, self-sufficient, responsible, and mature.

Women deserve to be acknowledged for what they are: Grown Ass Women.

And anything less just won’t do.

Carmen Rios is a Contributing Writer for Everyday Feminism. She splits her time disparately between feminist rabble-rousing, writing, public speaking, and flower-picking. A professional feminist by day and overemotional writer by night, Carmen is currently Communications Coordinator at the Feminist Majority Foundation and the Feminism and Community Editor at Autostraddle. You can follow her on Twitter @carmenriosss and Tumblr to learn more about her feelings.

This post is offensive for so many reasons.
 
Really? You don't know that "jokes" are one of the most power vehicles people use to promote hatred and discrimination against other groups? This is why I wish pre-meds included more social sciences in their undergrad education

thanks jamie, I called my Congressman and asked him to ban jokes

hillary 2016
 
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Topic: "Flying scalpels and the future of healthcare"

Discussion: Nurses suck - using girl = bad

Response: Blame liberals

Edit: Just catching everyone up with the thread so far.
 
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Honestly its not a bad article, anti-physician tone aside (the flying scalpel thing is really separate from most of the issues mentioned down article, and is the only issue that is overexagerated by the article). There has been a dangerous shift in many hospitals away from competent nursing care. I have seen floors with 8 patients per nurse. I have seen floors where nurses had a saner 4 patient:nurse ratio, but where the floor was being forced to accept patients that needed hourly checks who really needed 1:1 ICU care. It now seems to be a universal standard that all nurses need to have their schedules frantically rearranged, every single week, because the hospital has to send home any nurse that might possibly be less that 100% utilized on any given night. Of course there is an equally frantic efford to call them 4 hours later when the ED inevitably gets slammed.

At night, in my rural hospital, the most experienced medical provider on the floors is a nurse. When I'm on call its call in the traditional sense: I'm home and they have my number if they need me. The only doctor in the hospital is in the ED and she is not seeing my patients unless someone calls a code. We rely 100% for the nurses to assess and triage our patients at night. Its not a small issue that we are turning hospitals that used to be full of reasonably well reseted, well traine nurses into hospitals full of effectively untrained MAs theoretically overseen by one or two overextended, harassed nurse managers.
 
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Really? You don't know that "jokes" are one of the most power vehicles people use to promote hatred and discrimination against other groups? This is why I wish pre-meds included more social sciences in their undergrad education
I hate you. Srs, not joking.
 
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There are actually nursing staff ratio bills working their way through state governments currently. About 16 states have already passed some form of ratio and there was a federal bill modeled after the CA law but it died in Congress like every other bill the past few years.

https://www.cga.ct.gov/2004/rpt/2004-R-0212.htm

Even as a physician, I think this is a great idea if it gets nurses back to patient care and part of the medical team. I'd love to be able to go into a patient room where the nurse didn't have to chart nonsense and be frantically running around so we could actually talk about the patient and the nurse would be able to give good report.

The problem, like everything else, is how to pay for it.
 
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There are actually nursing staff ratio bills working their way through state governments currently. About 16 states have already passed some form of ratio and there was a federal bill modeled after the CA law but it died in Congress like every other bill the past few years.

https://www.cga.ct.gov/2004/rpt/2004-R-0212.htm

Even as a physician, I think this is a great idea if it gets nurses back to patient care and part of the medical team. I'd love to be able to go into a patient room where the nurse didn't have to chart nonsense and be frantically running around so we could actually talk about the patient and the nurse would be able to give good report.

The problem, like everything else, is how to pay for it.

It would be nice if we could treat professionals as professionals and assume that they did their jobs without having them document every single thing that they did. It's getting to the point where you practically have to document that you put a stethoscope on their chest and listened for 5 cycles at each of the 4 spots as you held their right hand with your left hand, fingers interlocking, for 30 seconds with a slight thumb caress to display compassion.
 
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It would be nice if we could treat professionals as professionals and assume that they did their jobs without having them document every single thing that they did. It's getting to the point where you practically have to document that you put a stethoscope on their chest and listened for 5 cycles at each of the 4 spots as you held their right hand with your left hand, fingers interlocking, for 30 seconds with a slight thumb caress to display compassion.
You forgot to document the color of stethoscope....now the hospital won't be reimbursed
 
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That research is nebulous and based on patient satisfaction surveys (at least the paper I read). Also, just look at their education. It is well below medical education and even PA education. You can go from nothing to NP in four years with almost no clinical experience and not much more than nursing theory and science for nurses courses.

And you can also go from nothing to MD in four years
 
BaaaaaaaaHaaaaaaaahaaaaa!!!!! Stretched thin????!!!!! No water? Dont have time to pee??? Just wait till residency.

And let me fix this for you: are nurses really this abusive to doctors? YES. YES THEY ARE.

No one should abuse anyone else. More civility between the professions is what our patients need us to have. But since physicians have more power than nurses, the duty to create civility starts with us--open a dialogue on dysfunctional work environments...
 
No one should abuse anyone else. More civility between the professions is what our patients need us to have. But since physicians have more power than nurses, the duty to create civility starts with us--open a dialogue on dysfunctional work environments...

Physician Alan Rosenstein has actually done a great job in this regard with his research and advocacy http://www.medscape.com/viewarticle/775407
 
So the definition of a word is now culturally inappropriate because a blog said so...

I also find the fact that you are a guy calling attention to this issue to be sexist. Women can't stand up for themselves? They need a white knight to come in and save them?

The reason you addressed the word girl was to attack the other poster and try to discredit what he was saying. That is why you said it with an attitude rather than in a way that was meant to educate the other poster. It is also an ad hominem argument that you posted this article rather than addressing the points I made that were germane to this thread

Edit: To be clear, I agree that "girl" is condescending when used in a condescending way (like if I said, "You don't know anything; you're just a girl"). Just like with all words, context matters.

And if you want to submit that blog post to an academic critique, I can show you that "boy" is used as often to refer to men as girl is to refer to women. And that both words can be used in a non-offensive way or be used with a condescending tone depending on the intention of the speaker

More people than this one writer has said girl is offensive! You really have to look up from the hard sciences books every so often and explore our culture. As far as me speaking out on behalf of women--it's the right thing to do to treat other people with respect. Civil rights passed in large part because a sizable number of white people joined black people to demand civility. The more dominant gender has an obligation to be civilized. And in terms of the usage of "boy," do you think, for instance, when a patient asks a nurse to speak to his/her physicians that s/he responds, "Sure, let me go get the boy"? That would be absurd and insulting.
 
More people than this one writer has said girl is offensive! You really have to look up from the hard sciences books every so often and explore our culture. As far as me speaking out on behalf of women--it's the right thing to do to treat other people with respect. Civil rights passed in large part because a sizable number of white people joined black people to demand civility. The more dominant gender has an obligation to be civilized. And in terms of the usage of "boy," do you think, for instance, when a patient asks a nurse to speak to his/her physicians that s/he responds, "Sure, let me go get the boy"? That would be absurd and insulting.
I worked construction. We would absolutely say "go grab the boys for lunch". It's not the ridiculous offense you dream it to be
 
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@JamesAK,

Why did you feel the need to post this entire article?

You need to stop comparing undergraduate and graduate education of NP's to physicians. It is based on two completely different models.

Can you imagine how many medical students worked as medical professionals before starting medical school? This argument that RNs have years of experience before going to NP school is baseless. It seems like it is a fall back whenever the nursing lobby attempts to compare the education of an RN/NP/CRNA/etc to that of a physician.

I have over a decade of experience as a pre-hospital care professional and my a** was in a sling the first week of medical school. At least I admit that n=1.

Edit:clarification and spelling

Sent from my iPhone using SDN mobile app

I don't have data on how many medical students worked in a hospital before going to medical school--please do share. But even if they did, unless they were practicing as professionals, they weren't learning at the same level and building their professional competence.

And sure, NPs should be able to have a residency as well, I don't know why there is not funding for that. But that NPs have outcomes at least equal to physician outcomes even without a residency suggests they may have a pretty good model that we might want to consider
 
Huge metaanalysis here https://www.nursingeconomics.net/ce/2013/article3001021.pdf And check out nurse-midwife care--better than physician care on many levels
Any randomized-controlled trials? The studies looked at 1990-2008 outcomes, were NPs working independently then or did they have physician oversight?

NPs are a good addition to a team of providers, but there is no reason for them to have independent practice rights and it puts patients at risk
 
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Huge metaanalysis here https://www.nursingeconomics.net/ce/2013/article3001021.pdf And check out nurse-midwife care--better than physician care on many levels

Every nurse on the internet posts this as if I'm going to read it or care. I've read quite a few nursing articles in my time and the complete lack of understanding of how to formulate a proper question, the absence of rigorous research methods, the poor data gathering/analysis and incredibly low quality of discussion is very strange. I doubt that they have even heard of the hawthorne effect, confounding bias, selection bias, etc. as I have never heard them discuss any of it. And yet nursing students spend much more time writing papers on the health disparities of the chachi population in ecuador than on things that matter like pharmacology and pathology. They do get rather familiar with following apa style though in that oh so critical bsn/msn/dnp which I'm sure will come in very handy when that paroxysmal a fib patient comes in.

There is nothing worse than overconfidence, especially when combined with inexperience and a subpar education
 
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Huge metaanalysis here https://www.nursingeconomics.net/ce/2013/article3001021.pdf And check out nurse-midwife care--better than physician care on many levels

No one is debating that NPs can be a valuable part of the medical team and a complement to the work of physicians that can improve healthcare outcomes. What people are contesting is the assertion often made by NPs that they should have greater autonomy because an NP working alone will have better outcomes than a physician working alone (this is what people are saying there is no reliable data for).

Even the article that you posted doesn't make that argument, despite the fact it is from the Journal of Nursing Economics, which I would suspect has a pro-nurse tilt. From the executive summary and the body of the article (bolded for emphasis):

This systematic review of published literature between 1990 and 2008 on care provided by APRNs indicates patient outcomes of care provided by nurse practitioners and certified nurse midwives in collaboration with physicians are similar to and in some ways better than care provided by physicians alone for the populations and in the settings included.
 
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I grew up in the Midwest and for the most part women actually like being called girls because it makes them feel young. I've been told this many times and never have been told I was being offensive. In fact, if I called a woman ma'm she would be more likely to be offended because she would think I thought she was old.

There's a difference in context and certainly a number of words that are offensive. However, this absurdity over girl, boy, he, she, etc is really going too far. People of a certain ideology are just looking for bones to pick these days because they relish the thought of feeling "better" than others and making others upset. Just stop and enjoy life. If you keep fretting over these things you'll never be happy.
 
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I grew up in the Midwest and for the most part women actually like being called girls because it makes them feel young. I've been told this many times and never have been told I was being offensive. In fact, if I called a woman ma'm she would be more likely to be offended because she would think I thought she was old.

There's a difference in context and certainly a number of words that are offensive. However, this absurdity over girl, boy, he, she, etc is really going too far. People of a certain ideology are just looking for bones to pick these days because they relish the thought of feeling "better" than others and making others upset. Just stop and enjoy life. If you keep fretting over these things you'll never be happy.

Man it's like when people get offended when someone is called black. They'll be gasping and falling all over themselves to tut at you while you're like my friend is black. They said they're okay with being called black because their skin is black. You aren't even black so what's your problem?
 
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Man it's like when people get offended when someone is called black. They'll be gasping and falling all over themselves to tut at you while you're like my friend is black. They said they're okay with being called black because their skin is black. You aren't even black so what's your problem?

Or like when 90% of native Americans recently polled (Google it) said they weren't bothered by "redskins."

I'm 1/16 native American so I can say that ;)
 
I wish i could get every np in a room and teach them how to actually evaluate medical research. Then we wouldn't have these tired and stupid talking points trotted out over and over again with the smugness of an atheist debunking the bible

They do have these classes in nursing school, you know
 
No one is debating that NPs can be a valuable part of the medical team and a complement to the work of physicians that can improve healthcare outcomes. What people are contesting is the assertion often made by NPs that they should have greater autonomy because an NP working alone will have better outcomes than a physician working alone (this is what people are saying there is no reliable data for).

Even the article that you posted doesn't make that argument, despite the fact it is from the Journal of Nursing Economics, which I would suspect has a pro-nurse tilt. From the executive summary and the body of the article (bolded for emphasis):

This systematic review of published literature between 1990 and 2008 on care provided by APRNs indicates patient outcomes of care provided by nurse practitioners and certified nurse midwives in collaboration with physicians are similar to and in some ways better than care provided by physicians alone for the populations and in the settings included.

Physicians who practice in collaboration with others also have better outcomes. People need to bounce ideas off of each other--a process not unique to nursing. The study authors included one physician and at least four public health professionals.
 
Physicians who practice in collaboration with others also have better outcomes. People need to bounce ideas off of each other--a process not unique to nursing. The study authors included one physician and at least four public health professionals.
It's not collaboration, it's supervision
 
More people than this one writer has said girl is offensive! You really have to look up from the hard sciences books every so often and explore our culture. As far as me speaking out on behalf of women--it's the right thing to do to treat other people with respect. Civil rights passed in large part because a sizable number of white people joined black people to demand civility. The more dominant gender has an obligation to be civilized. And in terms of the usage of "boy," do you think, for instance, when a patient asks a nurse to speak to his/her physicians that s/he responds, "Sure, let me go get the boy"? That would be absurd and insulting.

You are the type of person that is wrong with western society. Do you think in countries where they barely have enough food to eat they are getting offended and theorizing over the offensiveness of the word girl--a word that by definition means a young woman (and the young woman in question is 20 years old)? Here's a hint: no. They worry about having enough money to afford to eat. Or to clothe both their kids so they don't have to share one outfit and argue over who gets to wear the one pair of pants that day. Get some perspective.

Edit: oh, and I'm in the Navy. We absolutely call each other boys and girls. Grow up.
 
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A few corrections to some misinformation here and other comments:

Most states will allow a physician to practice independently after 1 year of residency. If you wanted, you could quit after intern year and hang up your shingle somewhere.

People asking about RCTs for this are setting the bar unreasonably high. The gold standard? Double blind RCT. Will never happen. The APN will always know s/he is an APN. For ethical reasons, I am sure the patient will know too. I suppose you could randomize the patient load. That being said, there are all kinds of things we do to patients using best available evidence with no hope of an RCT. You can argue about the quality of the evidence, but to demand that without an RCT you won't do it would invalidate a lot of what we do in practice.

The use of "girl" in the original post was clearly meant, in context, to be pejorative. It was an anti-APN post and the author used the diminutive "girl" in order to emphasize size the immaturity / inexperience of the nurses. I understand that "girl" is not always offensive, just as "boy" isn't. But seriously - in context, the use on the post in this thread was offensive and was meant to be that way. If it wasn't meant to be that way, then the author should choose his words more carefully next time.

People on this thread like to point out how dangerous overconfidence is, and they are right - it is a dangerous thing. However, overconfidence plagues physicians too. I see it all the time in practice. Can anyone provide data that APNs are more prone to overconfidence than physicians?
 
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Physicians who practice in collaboration with others also have better outcomes. People need to bounce ideas off of each other--a process not unique to nursing. The study authors included one physician and at least four public health professionals.

Physicians don't collaborate with one another, they consult. The relationship between a physician and a nurse extender is very different than the relationship between two physician colleagues.

By the way, can you imagine if the effort that went into those 28,000 articles about nurses vs physicians were put into something actually practical and valuable? Maybe they could have cured cancer instead of continuously advocating for increased nursing salaries at the expense of patient care. A large quantity of low quality data does not prove anything. And yet in every comment section that has to do with nps, these nonsense articles are put forth again and again. It is tiresome to argue with people who don't think.

ProfMD, your argument is specious. No insurance company would insure you and no hospital would give you privileges after a single year of training. That's a nonsense argument.

The vast majority of things we do don't have solid data backing it. A lot of practice is based on anecdotes and experience. Whether that is a good thing or not is up for debate. But that does not mean that evidence based medicine is the savior of patient care and that we should throw away all of our old practices and forget about using any critical thinking just because someone put their thoughts down on black and white in some paper in some journal even if it is the NEJM. Evidence and protocol should help when clinical judgment and common sense require some guidance. I don't need "data" to tell me that lesser trained providers will provide worse care. I have seen it many times already despite my relative lack of experience. In b4 blah blah blah good docs bad docs good nurses bad nurses means they are the same

I have no evidence that using a stethoscope changes management in a patient. Yet I will listen to everyone's heart and lungs because I have heard crackles that made me think to get a chest x-ray that showed infiltrates and I have listened to murmurs that led to echos and changed management. I also don't have any high quality evidence to show that everyone seen in the ED needs a ct scan and yet the magic radiation answer box seems to be required for most conditions.
 
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People on this thread like to point out how dangerous overconfidence is, and they are right - it is a dangerous thing. However, overconfidence plagues physicians too. I see it all the time in practice. Can anyone provide data that APNs are more prone to overconfidence than physicians?
nurses proposing they should act indepently of supervision is proof of a tendency toward overconfidence
 
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More people than this one writer has said girl is offensive! You really have to look up from the hard sciences books every so often and explore our culture. As far as me speaking out on behalf of women--it's the right thing to do to treat other people with respect. Civil rights passed in large part because a sizable number of white people joined black people to demand civility. The more dominant gender has an obligation to be civilized. And in terms of the usage of "boy," do you think, for instance, when a patient asks a nurse to speak to his/her physicians that s/he responds, "Sure, let me go get the boy"? That would be absurd and insulting.
So funny story, I actually double majored in a humanities subject (comparative literature- which is where you explore cultures through their literature)and I went to a school that requires 1 yr of humanities, 1 yr of sociology, 1 yr of history, and 2 art history classes in order to graduate. I've actually have quite a strong background in cultural understanding. And what you just did with your statement about getting my head out of a science book is called ad hominem argument.

The nurse wouldn't respond, "I'll go get the girl" either. He/she would say "I'll go get the doctor/him/her." Nice try. Riding in Cars with Boys, It's a Boy Girl Thing, Beautiful Boy, White Boys can't Jump etc (movies with adult males called boy in the title). "Atta boy," "White boy can dance," "I met a boy today," "This boy in my class..," "Boys are dumb," "The boys are back in town" And the list goes on for common sentences in which adult males are referred to as boys.
 
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nurses proposing they should act indepently of supervision is proof of a tendency toward overconfidence

Nurse practitioners wanting to use the training the have received is overconfidence? You can argue about whether this should be the case, and there are valid arguments. What about board certified PCPs who tell patients that surgery will fix their problem, the patient shows up in my office with bags packed, surprised that it is a consultation only, because their PCP told them they would get surgery. Turns out - they are not surgical candidate - sound like PCP overconfidence.

What about the intern who fails to call their senior or attending when a patient develops and arrhythmia - then the patients arrests.

What about the ED doc who sends patients home for outpatient follow up when they need urgent surgery.

These are all things that actually happen - with physicians. Your argument that "they are nurses - therefore they are overconfident" is a gross generalization and not valid.

Like I said - is there evidence that the APN suffers more from overconfidence than the PCP or intern or ED doctor? I have countless examples of these categories of physicians being overconfident, but I don't generalize to all PCPs or all interns or all ED doctors.

As for insurance companies and hospitals taking you without a complete residency - what do you think moonlighting is? It is residents practicing and getting paid for independent practice while they are still residents.

And, saying they less training makes a worse provider is also a specious argument. It may be true, but without evidence, you cannot say that. Are ED doctors from a 4 year residence definitely better than those who did 3 years? What about people in IM or peds who spend a 4th year as chief resident? Are they definitely better than their colleagues?
 
Nurse practitioners wanting to use the training the have received is overconfidence? You can argue about whether this should be the case, and there are valid arguments. What about board certified PCPs who tell patients that surgery will fix their problem, the patient shows up in my office with bags packed, surprised that it is a consultation only, because their PCP told them they would get surgery. Turns out - they are not surgical candidate - sound like PCP overconfidence.

What about the intern who fails to call their senior or attending when a patient develops and arrhythmia - then the patients arrests.

What about the ED doc who sends patients home for outpatient follow up when they need urgent surgery.

These are all things that actually happen - with physicians. Your argument that "they are nurses - therefore they are overconfident" is a gross generalization and not valid.

Like I said - is there evidence that the APN suffers more from overconfidence than the PCP or intern or ED doctor? I have countless examples of these categories of physicians being overconfident, but I don't generalize to all PCPs or all interns or all ED doctors.

As for insurance companies and hospitals taking you without a complete residency - what do you think moonlighting is? It is residents practicing and getting paid for independent practice while they are still residents.

And, saying they less training makes a worse provider is also a specious argument. It may be true, but without evidence, you cannot say that. Are ED doctors from a 4 year residence definitely better than those who did 3 years? What about people in IM or peds who spend a 4th year as chief resident? Are they definitely better than their colleagues?
You have my answer..
 
You are the type of person that is wrong with western society. Do you think in countries where they barely have enough food to eat they are getting offended and theorizing over the offensiveness of the word girl--a word that by definition means a young woman (and the young woman in question is 20 years old)? Here's a hint: no. They worry about having enough money to afford to eat. Or to clothe both their kids so they don't have to share one outfit and argue over who gets to wear the one pair of pants that day. Get some perspective.

Edit: oh, and I'm in the Navy. We absolutely call each other boys and girls. Grow up.

A lot of reasons women are disempowered lie in the use of language that values them less than their full worth and using "girl" is a part of creating that culture that underempowers women. Women and children bear the largest burden of poverty in nations without enough food. Men eat more than their share of protein, so women and children suffer. Just because people are hungry and are living in nations more dysfunctional than our own doesn't mean language doesn't affect them, or that society doesn't undervalue them. The underempowerment of women comes from the heads of men who take their power away. Ideas matter. Language matters.
 
Huge metaanalysis here https://www.nursingeconomics.net/ce/2013/article3001021.pdf And check out nurse-midwife care--better than physician care on many levels
None of that controls for acuity, patient load, or whether the nurses were supervised and had physician backup. I demand a direct, apples-to-apples comparison of independent FNPs with equal patient panels to FM docs over a long period of time (5-10 years) before anyone can claim "equal outcomes."
 
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Nurse practitioners wanting to use the training the have received is overconfidence? You can argue about whether this should be the case, and there are valid arguments. What about board certified PCPs who tell patients that surgery will fix their problem, the patient shows up in my office with bags packed, surprised that it is a consultation only, because their PCP told them they would get surgery. Turns out - they are not surgical candidate - sound like PCP overconfidence.

What about the intern who fails to call their senior or attending when a patient develops and arrhythmia - then the patients arrests.

What about the ED doc who sends patients home for outpatient follow up when they need urgent surgery.

These are all things that actually happen - with physicians. Your argument that "they are nurses - therefore they are overconfident" is a gross generalization and not valid.

Like I said - is there evidence that the APN suffers more from overconfidence than the PCP or intern or ED doctor? I have countless examples of these categories of physicians being overconfident, but I don't generalize to all PCPs or all interns or all ED doctors.

As for insurance companies and hospitals taking you without a complete residency - what do you think moonlighting is? It is residents practicing and getting paid for independent practice while they are still residents.

And, saying they less training makes a worse provider is also a specious argument. It may be true, but without evidence, you cannot say that. Are ED doctors from a 4 year residence definitely better than those who did 3 years? What about people in IM or peds who spend a 4th year as chief resident? Are they definitely better than their colleagues?

If nurse practitioners wanted to use their training to the fullest extent, they would spend their days writing 5 page papers about the health disparities of rural west virginia with wikipedia as the main citation. I wish I was joking.

If they were good and were actually equivalent, I would have nothing bad to say. I would just throw away my medical degree and sign up to be an np. But it doesn't even come close. It's an embarrassment to have them ape the attire and claim the legitimacy that the medical education and training affords doctors.
 
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You are the type of person that is wrong with western society.

How is this even something that would come out of a medical student's mouth? I am wrong to exist because I want to help disempowered groups gain some traction? Culture and science progress because people explore ideas with each other. Generally telling someone else they shouldn't even exist because they want to help others is not exactly moving things forward
 
But you can't practice until you have a residency- that's kind of a big difference and you're being completely disingenuous to not acknowledge it.

Yes, it is a different model for sure and I wish the government would invest more in nursing education. But we also have to look at the evidence that finds NP care to be at least as good as physician care, even without a residency. Evidence-based practice and all that
 
nurses proposing they should act indepently of supervision is proof of a tendency toward overconfidence
It's not just that- it's proof that our nation has become a place where ignorance is celebrated, for it makes you part of the masses, while excellence, hard work, wealth, and power are shunned, for they make you an "other." Anti-elitism, anti-intellectualism, anti-capitalism, all of it is abound in modern American society. People would rather be cared for by someone that is "like them" than the most skilled person possible, believes that the most skilled and talented should pretend to be equals with their subordinates even if it dumbs down business/education/healthcare, and believes any profession making a great sum must be inherently greedy or corrupt.

This nation is doomed, and that we're even debating nurses being equal to physicians is a clear sign of why. They clearly are not, and yet the public and populist policy makers so want to believe it that they bend over backwards to make reality fit their false truth. Every other first world nation meets their demand for services with physicians- only in America would way say that the masses deserve substandard care because the best is too expensive and nurse practitioners are "good enough."
 
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If nurse practitioners wanted to use their training to the fullest extent, they would spend their days writing 5 page papers about the health disparities of rural west virginia with wikipedia as the main citation.

Do you have any basis for this? I have friends who just finished their DNPs and their training and classes were extremely rigorous. Just because people go to graduate school in a science that is not medicine doesn't mean it's Sesame Street, you know.
 
Yes, it is a different model for sure and I wish the government would invest more in nursing education. But we also have to look at the evidence that finds NP care to be at least as good as physician care, even without a residency. Evidence-based practice and all that
The quality of the evidence is extremely poor. It's like saying building cars out of particle board has been proven to be completely safe because you crash-tested then at 10 miles per hour with foam bumpers. These are studies that only an idiot or someone with an agenda would find adequate.
 
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