Leveling the playing field

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Taurus

Paul Revere of Medicine
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This rule is long overdue. Why target just physicians and dentists? If there are NP's out there who think that they can function like physicians, then put them through the same ringer that physicians go through. If the LA Times expose on nursing is any indication, the new captured information will be very interesting to analyze. Next, I want to see NP's face recertification exams just like physicians and PA's.

National Practitioner Data Bank expanded

Disciplinary action on nurses, chiropractors, podiatrists and physician assistants will be included.

By Amy Lynn Sorrel, amednews staff. Posted March 4.

A new federal rule has expanded the scope of the National Practitioner Data Bank to include disciplinary information not just on physicians but on all licensed health care professionals.

In an effort to promote patient safety, the confidential reporting system was established under the federal Health Care Quality and Improvement Act of 1986 to give hospitals a snapshot of any issues with a doctor's competence or conduct before credentialing.

A final rule published Jan. 28 by the Dept. of Health and Human Services expanded the data reported to the Health Resources and Services Administration, which administers the data bank, to include adverse actions taken against licensed health care professionals. That includes nurses, chiropractors, podiatrists and physician assistants. The rule, published in the Federal Register, is available online (edocket.access.gpo.gov/2010/pdf/2010-1514.pdf).

Before the new rule, the data bank collected negative findings only against physicians and dentists by state licensing agencies, such as medical boards, or credentialing bodies, such as hospitals. Similar information on other health professionals previously was gathered in a separate reporting database.

The regulation, set to take effect March 1, also requires additional entities, such as peer review and private accreditation organizations, to report adverse actions against health professionals. The National Practitioner Data Bank already had similar reporting requirements regarding doctors.

The recent changes were mandated to incorporate statutory requirements in the Medicare and Medicaid Patient and Program Protection Act of 1987 and the Omnibus Budget Reconciliation Act of 1990.​

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I'm 100% for transparency and accountability.
 
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Methinks Taurus is going to have to find something else to cry about.
 
Methinks Taurus is going to have to find something else to cry about.

At least make it a little more dramatic. I know, spring break is nearly upon us; perhaps something on the lines of topless doctor nurse practitioners gone wild in Cancun would be a little more dramatic.
 
It won't take long. He's good at it.

For the record, his views are shared by many med students and doctors, we just aren't as vocal about it (perhaps to our own detriment). People can't keep taking potshots at us unless they want to alienate, insult, disappoint, and put doctors out of business, and if that's what people really want, that's really sad. Personally, I applaud Taurus for fighting for what he believes in, righteously defending his profession, and taking your slings and arrows for it.
 
You also must realise that many of us nurses are against the DNP/NP gone wild movement as well. I've taken a few for the team on nursing forums regarding this issue. However, I do not think continuing to complain about the issue on a clinicians thread in a public forum will do much good. This is an issue that requires actions echelons beyond the frequent debates encountered here.
 
I just finished a DNP course that I took for an elective on financial and business concepts for nurses. It was challenging even with an MBA under my belt. I can see it being important for those who are involved in healthcare projects, starting their own business or even in creating healthcare options for people. But, I'd still like to see more clinical courses in the DNP program.
 
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You also must realise that many of us nurses are against the DNP/NP gone wild movement as well. I've taken a few for the team on nursing forums regarding this issue. However, I do not think continuing to complain about the issue on a clinicians thread in a public forum will do much good. This is an issue that requires actions echelons beyond the frequent debates encountered here.

Amen.
 
You also must realise that many of us nurses are against the DNP/NP gone wild movement as well. I've taken a few for the team on nursing forums regarding this issue. However, I do not think continuing to complain about the issue on a clinicians thread in a public forum will do much good. This is an issue that requires actions echelons beyond the frequent debates encountered here.

Cool. Good to know we have friends.

But for what it's worth, I don't think it's worthless to post on a clinicians thread in a public forum. He looks up citations and shows them (some good, some biased, but the reader should be able to discern the relevence & strength of evidence), makes some valid points, and generally only argues in threads that address the controversial issue of the DNP. It's better than just sitting silently, sighing heavily, being disappointed, resenting the people who are causing you pain or consternation, which is what most of us do, and it's part of the reason doctors are losing the public's faith - we always figured "jeez, we're doctors for crying out loud, who would have the gall to push us out of patient care, or shake the patient's faith in us"? I mean it takes a pretty bad doctor for a nurse, even a cantankerous (hypothetical) one to actually enter the patient's room and shake the patient's faith in their doctor, or suggest an alternative outside the patient/doctor relationship. There's an appropriate way to go about suggesting alternatives, and it doesn't involve marketing yourself as the same as a doctor so come see me, listen to me. Basically, that's what's happening on a larger, public stage. And personally, I don't think we deserve it.

I think we've made alot of progress in the healthcare team approach, everyone on the team is getting more input, we're getting all PC and collegial, and that's generally a good thing. There's a line that shouldn't be crossed, confrontations that can be very harmful, and I'm of the opinion that that line is being violated. It sounds like some of you guys agree and that's great.
 
You also must realise that many of us nurses are against the DNP/NP gone wild movement as well. I've taken a few for the team on nursing forums regarding this issue. However, I do not think continuing to complain about the issue on a clinicians thread in a public forum will do much good. This is an issue that requires actions echelons beyond the frequent debates encountered here.

I hear what you're saying, but where is the enemy? Who is the enemy? Is it a degree? An entire group? Enlighten me. Sometimes it seems to me like some are like a religious group who sees the devil everywhere, lol!
 
That's sort of my point, some people seem to get their jollies by implying all nurses are militant physician haters.

The problem IMHO, is a militant group of nurses who are pushing for complete and total NP independent practice. No collaboration, no chart reviews, no teamwork nadda.

I am all for DNP degrees and additional education, but a clinical doctoral and a few hundred more hours of clinical experience should give you all the rights and privileges of a physician?

In addition, it does not sit well with me on an intuitive level when I work with these practitioners and even have them in classes and I am consistently stunned by the lack of general knowledge in some cases. You don't know the structure of a beta receptor or the adenyl cyclase and cAMP relationship, yet you are the one prescribing my Toprol-XL?

I have no problem with advanced practice nurses; however, I think we should live up to our frequently spouted mantra of teamwork. Yet, I often find "militant" nursing cramming agendas down the throats of other professions. Them, these same providers cry foul play when the table turns the other way. Paramedics working in the hospital anybody? Frankly, I find the hypocrisy quite disturbing.

Sure, there are crappy physicians and many physician issues; however, pointing to the behavior of others to justify your own bad behavior is kindergarden politics. I would also like to see nursing put additional focus back to the bedside and on safety practices that benefit provider and patient. This is a primary function of nursing IMHO, one that has been neglected in the push for the holy grail of indi practice.
 
I hear what you're saying, but where is the enemy? Who is the enemy? Is it a degree? An entire group? Enlighten me. Sometimes it seems to me like some are like a religious group who sees the devil everywhere, lol!
The enemy is the belief that very little basic science + a few hundred hours of clinical training is enough to practice independently. And then adding a few MPH courses and calling it a clinical doctorate.

No one's against more education or anything like that. However, when it takes physicians a minimum of 7 years of intense training to earn the right to practice independently, what makes the NP/DNP independence movement think they can shortcut through it?
 
That's sort of my point, some people seem to get their jollies by implying all nurses are militant physician haters.

The problem IMHO, is a militant group of nurses who are pushing for complete and total NP independent practice. No collaboration, no chart reviews, no teamwork nadda.

What about the states where NPs are not required to have any physician collaboration whatsoever? What kind of info is coming out of these states? I don't know. Is there any? Any studies?

I am all for DNP degrees and additional education, but a clinical doctoral and a few hundred more hours of clinical experience should give you all the rights and privileges of a physician?

Maybe physicians have too many hours. Has anyone looked at that? Hey, nurses went with less hours and it didn't seem to destroy the profession...right?

In addition, it does not sit well with me on an intuitive level when I work with these practitioners and even have them in classes and I am consistently stunned by the lack of general knowledge in some cases. You don't know the structure of a beta receptor or the adenyl cyclase and cAMP relationship, yet you are the one prescribing my Toprol-XL?

Luckily, I don't prescribe Toprol. I deal with psychopharmacology. Our drugs are hypothetically thought to work on certain areas of the brain that are hypothetically thought to cause certain symptoms. Hypothetically, our patients should get better.:D

I do find it funny when physicians rant about NPs taking over, say family practice, yet no physician wants FP. Someone is going to step up and fill that hole if you don't.
 

I keep holding out for a link to a scholarly article with evidence. People magazine? Really? And the picture comment, what are you 12? If you want to lend some crediblity to your argument, you must do better.

I don't automatically endorse Mundinger's model of care, nor am I going to automatically dismiss it. Let there be proof.
 
I keep holding out for a link to a scholarly article with evidence. People magazine? Really? And the picture comment, what are you 12? If you want to lend some crediblity to your argument, you must do better.

I don't automatically endorse Mundinger's model of care, nor am I going to automatically dismiss it. Let there be proof.


dude...it was a JOKE.....But seriously...online adn to dnp in 4 yrs part time(see the umass dnp program)...give me a break....where is the clinical time?
there is no way someone with 1500 hrs or less of clinical time deserves a doctorate and the right to practice medicine independently.....a pa with a certificate(not even an a.s.) has more clinical time and still needs a sponsoring physician....
 
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I keep holding out for a link to a scholarly article with evidence. People magazine? Really? And the picture comment, what are you 12? If you want to lend some crediblity to your argument, you must do better.

I don't automatically endorse Mundinger's model of care, nor am I going to automatically dismiss it. Let there be proof.
Evidence of what?
 
What about the states where NPs are not required to have any physician collaboration whatsoever? What kind of info is coming out of these states? I don't know. Is there any? Any studies?



Maybe physicians have too many hours. Has anyone looked at that? Hey, nurses went with less hours and it didn't seem to destroy the profession...right?



Luckily, I don't prescribe Toprol. I deal with psychopharmacology. Our drugs are hypothetically thought to work on certain areas of the brain that are hypothetically thought to cause certain symptoms. Hypothetically, our patients should get better.:D

I do find it funny when physicians rant about NPs taking over, say family practice, yet no physician wants FP. Someone is going to step up and fill that hole if you don't.
There are no valid studies without significant flaws or biases that suggest NPs/DNPs are safe.

I doubt physicians have too many hours of training. I hope you realize that there's a vast amount of information out there now that you have to know. You can't shortcut your way through learning it.

I find it funny that NPs/DNPs (who are likely a part of the reason why physicians don't want to do FP) think that it's okay to replace a physician with 7 years of intense training with barely half of that. I also find it funny that they always cite the same flawed studies to support their statements that they're equal/superior to physicians. It appears that critical thinking wasn't a part of the curriculum (even though they take several stats courses).

Why don't we just let 4th year med students practice FP independently then? They have a heck of a lot more basic science and clinical training than the NP+DNP combined. Let them "step up and fill the hole" rather than lesser trained individuals. Sound like a good idea zenman?
 
I don't want to get in to the middle of this drama. . .it seems it's an age old fight.
Nonetheless I will say I am in a DNP and likely will drop out--I think it's total BS. Mine is not an online; it's 2.5 years of academia with some clinical.
I work in an academic institution as a hospitalist. I have ridiculous critical care experience and sound clinical skills. I am thankful I work with a great group of docs/pa/np .
However the DNP in my opinion is a money maker. In a profession that can not determine the entry level for the RN suddenly the entry level for the NP is a doctorate?
I also teach and have recently have accelerated students from RN to NP. They get their RN while in school. Some i know will do okay based on their previous work (emt-c) others i can't imagine how they will function.

P.S. will likely drop the DNP program after today.
 
Hey, nurses went with less hours and it didn't seem to destroy the profession...right?

That's debatable.

Many of the "nurses" running around these days are actually CNAs and MAs. The public can't tell the difference. Most doctors don't care. How does that reflect on nursing?

I do find it funny when physicians rant about NPs taking over, say family practice, yet no physician wants FP. Someone is going to step up and fill that hole if you don't.

Why would they? The issue is reimbursement. Why would a mid-level go into primary care if they could make more money working in a specialty?
 
There are no valid studies without significant flaws or biases that suggest NPs/DNPs are safe.

I doubt physicians have too many hours of training. I hope you realize that there's a vast amount of information out there now that you have to know. You can't shortcut your way through learning it.

I find it funny that NPs/DNPs (who are likely a part of the reason why physicians don't want to do FP) think that it's okay to replace a physician with 7 years of intense training with barely half of that. I also find it funny that they always cite the same flawed studies to support their statements that they're equal/superior to physicians. It appears that critical thinking wasn't a part of the curriculum (even though they take several stats courses).

You'll find me quoting few studies as I think most have their problems. However, critical thinking is part of undergrad nursing...just to bring ya up to speed. I also don't think NPs are the reason FP is not popular.

Why don't we just let 4th year med students practice FP independently then? They have a heck of a lot more basic science and clinical training than the NP+DNP combined. Let them "step up and fill the hole" rather than lesser trained individuals. Sound like a good idea zenman?

If a needed hole is left unfilled, someone needs to fill it. I don't care if you put Special Forces medics in every 10 square miles.
 
That's debatable.

Many of the "nurses" running around these days are actually CNAs and MAs. The public can't tell the difference. Most doctors don't care. How does that reflect on nursing?

That was tongue-in-cheek, Blue Dog. I personally think the ADN was a knee-jerk reaction to a nursing shortage and nursing has never been able to get it together...for some reason. (I'm not knocking holders of the ADN, just the concept of it.)



Why would they? The issue is reimbursement. Why would a mid-level go into primary care if they could make more money working in a specialty?

I was originally an FNP student, but if I never hear another parent hold up their little loin puppies and go, "goo, goo" it will be too soon for me.
 
That's what I thought. The enemy is one person...a 73 yr old grandmother that few listen to...:laugh:
isn't she almost singlehandedly responsible for the origin of the watered down dnp curriculum and the requirement that all np's have a dnp 5 yrs from now?
if she hadn't started the trend at columbia, np's could still get educated at the ms level in order to provide the same(or better) care than the dnp will offer. the addition of the doctorate adds nothing but administrative and management courses and maybe 500 hrs of clinical time to the ms. I would have prefered just mandating the extra 500 hrs within the ms and/or bringing every program up to a minimum of 1500-2000 clinical hrs.
np's deliver good care and myself and my family have benefited from it but I don't think the dnp improves things for clinical np's in any way unless they want to work in administration or teach.
that is why the dnp should be optional....
 
dude...it was a JOKE.....But seriously...online adn to dnp in 4 yrs part time(see the umass dnp program)...give me a break....where is the clinical time?
there is no way someone with 1500 hrs or less of clinical time deserves a doctorate and the right to practice medicine independently.....a pa with a certificate(not even an a.s.) has more clinical time and still needs a sponsoring physician....

I'm down with humor. However, people are as serious about this issue as a heart attack and if that is the position they are coming from, their arguments should be rational and serious as well.

Which yes, the disparity of clinical hours as well as didactic material is a completely valid concern, as is the concern that such a person can safely practice independently.

When there is a question of best practices in medicine, what oh what is there to do? Rant and rave about how unfair it is and medicine sucks? Dey took er jerbs!! (Not suggesting that you do- just illustrating a point). Because that just sounds like a bitter whiney personal problem.

No, when there are issues regarding best practice, the legitimate response is to look at the outcomes. Is research infallible? Of course not. But that doesn't mean it is useless either. As mentioned earlier, many consider the existing research flawed and biased. Fair enough, so if you (speaking to the general) are so passionate about it, get yourself a research grant and conduct your own study.

As an aside, I'm not a dude.

Evidence of what?

Outcomes. Isn't that what the concern here is for? Patient health and safety?
 
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Many of the "nurses" running around these days are actually CNAs and MAs. The public can't tell the difference. Most doctors don't care. How does that reflect on nursing?


Are you trying to tell me that most doctors would be comfortable with leaving ill/injured people to monitored and medicated by people whose extent of their training is to take vital signs, feed and bathe, and maybe give a SQ or IM injection- under RN/MD supervision at that?

I hope you're just trying to draw a corollary between DNPs and physicians rather than making a real assertion.

Sure every physician can give an example of an RN that lacked knowledge on some subject or demonstrated poor judgement in some circumstance. (And that street goes two ways, for sure.) However, even a physician who has a load of contempt for RNs would be hard pressed to leave a patient in the hands of only a CNA or MA.

As for, "How does that reflect on nursing?"-

Say I'm wrong about physicians actually believing RNs to be valuable. Where then is the big physician lobby to make healthcare more affordable by replacing RNs with CNAs/MAs? :laugh: Yeah, didn't think so.

Clearly, every discipline has its role and if that is the point you're trying to make (the DNP shouldn't try to assume the physician role), then just say it without trying to belittle the nursing profession.:cool:
 
Outcomes. Isn't that what the concern here is for? Patient health and safety?
The burden of proof is on the NP/DNP community to provide studies that show that their outcomes are equivalent to those of physicians. It's not the physicians' job to show that NPs/DNPs are not safe. That's not how science works. And, at the moment, I have not come across any studies that weren't significantly flawed (ie. measured useless things, used patient satisfaction surveys as a measure of outcomes, etc).
 
Clearly, every discipline has its role and if that is the point you're trying to make (the DNP shouldn't try to assume the physician role), then just say it without trying to belittle the nursing profession.

The point I'm making is that academic nursing has shot itself in the foot by emphasizing advanced practice over bedside nursing.
 
As an aside, I'm not a dude.

as an aside, I'm from california.
everyone is a dude.
dudette just doesn't work.
dude is like flight attendant. it's neuter.ok, maybe it isn't but like I said....california...

dudes - Any group of people, regardless of gender
en.wiktionary.org/wiki/dudes
 
The burden of proof is on the NP/DNP community to provide studies that show that their outcomes are equivalent to those of physicians. It's not the physicians' job to show that NPs/DNPs are not safe. That's not how science works. And, at the moment, I have not come across any studies that weren't significantly flawed (ie. measured useless things, used patient satisfaction surveys as a measure of outcomes, etc).

It's not about who has the "burden" of proof. That is not how science works. That can be taken up by anyone with a vested interest which includes public health policy makers, DNP/NPs, and actually yes physicians (the concern over midlevel salaries/training hours/boundaries is brought up everyday). If a person has an argument to make, s/he needs to bring his/her own evidence to the table. If you have ideas for improving the validity of DNP/NP outcome studies, contact your local Sigma Theta Tau chapter and discuss your proposals with one of the members- you'll likely have no problem finding someone with an interest in that topic.

The point I'm making is that academic nursing has shot itself in the foot by emphasizing advanced practice over bedside nursing.

It just may be that I'm staying up wayyyy too late, but I'm not getting what you mean by this.

as an aside, I'm from california.
everyone is a dude.
dudette just doesn't work.
dude is like flight attendant. it's neuter.ok, maybe it isn't but like I said....california...

dudes - Any group of people, regardless of gender
en.wiktionary.org/wiki/dudes

:laugh: I've got a pretty good handle on the gender neutrality of dude- being Californian and whatnot. But isn't that so '90's? Like "hella".

(I probably still say "dude" and "hella" myself :D)
 
It's not about who has the "burden" of proof. That is not how science works. That can be taken up by anyone with a vested interest which includes public health policy makers, DNP/NPs, and actually yes physicians (the concern over midlevel salaries/training hours/boundaries is brought up everyday). If a person has an argument to make, s/he needs to bring his/her own evidence to the table. If you have ideas for improving the validity of DNP/NP outcome studies, contact your local Sigma Theta Tau chapter and discuss your proposals with one of the members- you'll likely have no problem finding someone with an interest in that topic.

Sorry but you're wrong about this. The burden of proof on a new, proposed alternative to the gold standard is to prove it should be used, not to prove it shouldn't. Take drugs for example. We (the FDA) don't just all take their word for it that some new drug is better than the old drug, nor do we accept their studies as proof that they have a place in patient care if they've got sources of bias that confound the point they're trying to make. It's not the public's job to study every proposed drug or treatment alternative or provider. Drugs are at least tested on animals and desperate cases and tiny patient samples before even being considered for a large study. We don't just assume a new drug is going to be as good or better, open the floodgates and test outcomes retrospectively. We don't just assume by default everyone can practice medicine and then maybe challenge it after the fact.
 
It's not about who has the "burden" of proof. That is not how science works. That can be taken up by anyone with a vested interest which includes public health policy makers, DNP/NPs, and actually yes physicians (the concern over midlevel salaries/training hours/boundaries is brought up everyday). If a person has an argument to make, s/he needs to bring his/her own evidence to the table. If you have ideas for improving the validity of DNP/NP outcome studies, contact your local Sigma Theta Tau chapter and discuss your proposals with one of the members- you'll likely have no problem finding someone with an interest in that topic.
Wrong.

Take a basic stats class and you'll understand experimental design and who has the burden of proof, etc. Also, read what JeffLebowski said.

I was absolutely right when I said that the burden of proof is on the midlevels. It's not up to the rest of society to suggest ways their studies can be done better. It's up to them to come up with the experimental design. Like I said, the ones out there so far have huge flaws in them, not some minor ones which could be found in many studies. The NPs/DNPs are the ones that are saying they provide equivalent (and superior, in some cases :laugh:) care as physicians; it's up to them to design a study that shows this.
 
I don't recall anywhere in my Phd progam saying that one group has a particular burden to prove something. In fact, part of the scientific method is to design experiments that can be verified by other groups in order to ensure the results are in line with the conclusions drawn and reduce bias. Anyone can design a study to look at the efficacy of one provider over another. However, statistically you aren't looking to see which group is better you are looking to reject the null hypothesis, which in this case may be that mid-level care is no better than physician care at whatever alpha you set (alpha=0.05). So, I don't think that the DNPs have to prove it, but I certainly think the physicians should investigate it in order to stop DNP "creep."
 
I don't recall anywhere in my Phd progam saying that one group has a particular burden to prove something. In fact, part of the scientific method is to design experiments that can be verified by other groups in order to ensure the results are in line with the conclusions drawn and reduce bias. Anyone can design a study to look at the efficacy of one provider over another. However, statistically you aren't looking to see which group is better you are looking to reject the null hypothesis, which in this case may be that mid-level care is no better than physician care at whatever alpha you set (alpha=0.05). So, I don't think that the DNPs have to prove it, but I certainly think the physicians should investigate it in order to stop DNP "creep."
Once again, it's not up to others to disprove something. It's up to the party making the claim (null hyp: NP/DNP outcomes = physician outcomes) to design and carry out a valid study to draw inferences from. For example, it's not up to the rest of society to prove that a drug a pharma company is advertising doesn't work as well as they say it works. It's up to company to show that it works as well as they say it does.
 
I think the real disservice is being done to the nursing students, who now have to pony up an extra 1.5 years of tuition for minimal return. Think about it. $45-60K for a couple hundred hours of clinical experience, some management courses (nursing theory, etc), and some stats/epidemiology? None of which will help you take care of a patient that much better than if you had just gotten your NP. I doubt it's a huge push for independence that's driving this.
 
Sorry but you're wrong about this. The burden of proof on a new, proposed alternative to the gold standard is to prove it should be used, not to prove it shouldn't. Take drugs for example. We (the FDA) don't just all take their word for it that some new drug is better than the old drug, nor do we accept their studies as proof that they have a place in patient care if they've got sources of bias that confound the point they're trying to make. It's not the public's job to study every proposed drug or treatment alternative or provider. Drugs are at least tested on animals and desperate cases and tiny patient samples before even being considered for a large study. We don't just assume a new drug is going to be as good or better, open the floodgates and test outcomes retrospectively. We don't just assume by default everyone can practice medicine and then maybe challenge it after the fact.

I agree with this. Studies have been conducted, data collected, published, etc. Your review (however extensive, I really don't know) of the published research finds it insufficient to support a conclusion that midlevel providers are just as effective than physicians in a primary care capacity. It's more than reasonable to want to see more/better evidence. It is more than reasonable to expect proponents of this model of care to produce such evidence, as I imagine is currently going on. Honestly, this not a battle I'm personally invested in (and really have no opinion on the subject), but I do like to see rational and logical discussion. If you're coming from a position that more evidence is needed to support midlevel equality, cool. When you (speaking in generals) are coming from a position that hellz no, absolutely not, well then yeah, I think that it is reasonable to expect some hard number back up. Like I said, there are many stake holders in this issue and outcomes are more meaningful when examined from many viewpoints. You'll never eliminate investigator bias when midlevels are the only ones conducting the research, right?
Wrong.

Take a basic stats class and you'll understand experimental design and who has the burden of proof, etc. Also, read what JeffLebowski said.

I was absolutely right when I said that the burden of proof is on the midlevels. It's not up to the rest of society to suggest ways their studies can be done better. It's up to them to come up with the experimental design. Like I said, the ones out there so far have huge flaws in them, not some minor ones which could be found in many studies. The NPs/DNPs are the ones that are saying they provide equivalent (and superior, in some cases :laugh:) care as physicians; it's up to them to design a study that shows this.

Take a class in RESEARCH and get back to me on how truly "experimental" a study can plausibly be when looking at midlevel outcomes. Have you written a formal editorial to any journals where these studies have been published giving your critique? If you really believe the science is lacking, and it is an important issue to you, what are you doing about it?
 
Once again, it's not up to others to disprove something. It's up to the party making the claim (null hyp: NP/DNP outcomes = physician outcomes) to design and carry out a valid study to draw inferences from. For example, it's not up to the rest of society to prove that a drug a pharma company is advertising doesn't work as well as they say it works. It's up to company to show that it works as well as they say it does.

Where are the requirements that state the party making the claim has to be the one that designs and carries out the research? I agree they should, but I have never come across such a requirement. It would validate their claims. As long as research bears out that something is effective then is should be acceptable. Also, you are right when you say it isn't society's problem to determine to perform research it is the scientific communities problem, which will look at research performed by others to determine if it plausible/repeatable either by peer review and/or experimental repeatability. No one expects to do research on a particular medication when a physician places them on it, but they expect that it has been done by pharma with oversight from the FDA and sometimes a contracted CRO. Research within one profession is not always confined to the particular area and there is much overlap which ensures that the correct conclusions are reached and that profession isn't making false claims.
 
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The current "rule" is:

DNP/NPs: "We provide care equal to that of other physicians in our speciality."

MDs: "No you do not."

Under current burden of proof "rules" the MD are correct...even if they are not. The DNP/NPs must provide proof. Then when they do, the other side tries their best to show that it is wrong. Twenty years later, it is accepted that one side is correct. Simple, actually.
 
dude...it was a JOKE.....But seriously...online adn to dnp in 4 yrs part time(see the umass dnp program)...give me a break....where is the clinical time?
there is no way someone with 1500 hrs or less of clinical time deserves a doctorate and the right to practice medicine independently.....a pa with a certificate(not even an a.s.) has more clinical time and still needs a sponsoring physician....

I went to the umass dnp program website http://www.umass.edu/nursing/programs/pro_grad_DNP/DNP_Flyer.pdf , 79-81 credits post BS (those with AD needed BS in another field) I didnt find the 4 year part time option for 79-81 credits. Wouldn't 79 credits over 4 years be about 20 credits per year, isnt full time graduate school usually 8-9 credits per semester?
 
Take a class in RESEARCH and get back to me on how truly "experimental" a study can plausibly be when looking at midlevel outcomes. Have you written a formal editorial to any journals where these studies have been published giving your critique? If you really believe the science is lacking, and it is an important issue to you, what are you doing about it?
What's a class on research? I've been doing research for 1.5yrs but I have no clue what you mean by a "class" on research. I can assure you that I understand experimental design at a reasonable enough level to see how flawed the current studies are. Heck, I'd even go as far as saying that even someone with no statistics background could see how flawed the often cited (by midlevels) studies are.

It's up to the investigators to provide a study where the science isn't lacking, not to put out badly designed studies and hope someone else has to waste their funds on rectifying the mistakes of the study.

As an aside, I essentially said the same thing as JeffLebowski regarding the burden of proof. I'm a little confused how you agreed with him and then disagreed with me.
 
The current "rule" is:

DNP/NPs: "We provide care equal to that of other physicians in our speciality."

MDs: "No you do not."

Under current burden of proof "rules" the MD are correct...even if they are not. The DNP/NPs must provide proof. Then when they do, the other side tries their best to show that it is wrong. Twenty years later, it is accepted that one side is correct. Simple, actually.
zenman, why don't assess these studies for yourself then? Surely you can't miss some of those huge flaws in design. Put out a well-designed study and the other side won't be able to show that it's wrong. However, when you put out badly designed studies and make inferences off of them, of course you're going to face some harsh criticism. It's that simple.
 
The bottom line is that if research is put out by a group with a vested interest it should be check by an independent investigator. The first thing I always do when I read peer reviewed articles is to look at who funded the research, which is usually listed in the acknowledgements.
 
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