Comments on: My take: Dr. Nurses, supporting universal care http://www.kevinmd.com/blog/2008/04/my-take-dr-nurses-supporting-universal.html medical blog Sun, 22 Nov 2009 19:59:44 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2008/04/my-take-dr-nurses-supporting-universal.html/comment-page-1#comment-84771 Anonymous Fri, 04 Apr 2008 01:07:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-dr-nurses-supporting-universal-care.html#comment-84771 Dave I appreciate your response but you've really only confirmed my point. Annie (and others, inlcuding Dr. Mudinger) have basically justified the creation of this degree as a means of getting more doctorally prepared nurses into research and faculty. As you plainly say, the purpose of the DNP is to better prepare existing nurse practitioners for clinical practice. More NPs does little to directly address the bedside RN shortage. So the question still remains, regarding this degree.... why? Dave I appreciate your response but you’ve really only confirmed my point. Annie (and others, inlcuding Dr. Mudinger) have basically justified the creation of this degree as a means of getting more doctorally prepared nurses into research and faculty. As you plainly say, the purpose of the DNP is to better prepare existing nurse practitioners for clinical practice. More NPs does little to directly address the bedside RN shortage. So the question still remains, regarding this degree…. why?

]]> By: Anonymous http://www.kevinmd.com/blog/2008/04/my-take-dr-nurses-supporting-universal.html/comment-page-1#comment-84757 Anonymous Thu, 03 Apr 2008 19:33:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-dr-nurses-supporting-universal-care.html#comment-84757 The difference between DNPs & EdDs, PhDs and such is DNPs are clinical focus. PhDs are research based, EdDs are education based (school). Moving NPs to a DNP is not dissimilar to moving pharmacists (masters level) to DPhs. As far as NPs not having a standard exam is partly true. It varies state to state. Here in Mississippi all NPs much pass an exam in order to practice. Simply having a MSN as a NP does not allow practice. Like medicine there are specialties: Geriatrics, Family, Adult Acute Care, Psych & Neonatal. Each has its own exam one must pass due to each being its own specialty.<br/><br/>There's my 2 cents.<br/>-Dave, MBA, CCRN, CFN The difference between DNPs & EdDs, PhDs and such is DNPs are clinical focus. PhDs are research based, EdDs are education based (school). Moving NPs to a DNP is not dissimilar to moving pharmacists (masters level) to DPhs. As far as NPs not having a standard exam is partly true. It varies state to state. Here in Mississippi all NPs much pass an exam in order to practice. Simply having a MSN as a NP does not allow practice. Like medicine there are specialties: Geriatrics, Family, Adult Acute Care, Psych & Neonatal. Each has its own exam one must pass due to each being its own specialty.

There’s my 2 cents.
-Dave, MBA, CCRN, CFN

]]> By: Anonymous http://www.kevinmd.com/blog/2008/04/my-take-dr-nurses-supporting-universal.html/comment-page-1#comment-84755 Anonymous Thu, 03 Apr 2008 19:03:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-dr-nurses-supporting-universal-care.html#comment-84755 "I support universal coverage, but not before controlling costs and expanding primary care access."<br/><br/>You have to have universal coverage to have some massive "cost control" and "primary care expansion." At least if you're going to have it as a large organized plan. “I support universal coverage, but not before controlling costs and expanding primary care access.”

You have to have universal coverage to have some massive “cost control” and “primary care expansion.” At least if you’re going to have it as a large organized plan.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/04/my-take-dr-nurses-supporting-universal.html/comment-page-1#comment-84748 Anonymous Thu, 03 Apr 2008 02:10:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-dr-nurses-supporting-universal-care.html#comment-84748 What specific words in Kevin's entry actually indicate a gender bias on his part? True the majority of nurses are women, but so are the majority of current medical students. And the most of them would probably concur with his position. <br/><br/>As a woman in medicine, I find that accusation to be intellectually dishonest and cheap. You can debate the issue on its merits without resorting to baselessly accusing the "other side" of engaging in some kind of sexism because they happen to disagree with you. <br/><br/>I assure you that I and most other physicans and medical students would feel similarly about a doctoral physician assistant degree, a field in which at least half are male. What specific words in Kevin’s entry actually indicate a gender bias on his part? True the majority of nurses are women, but so are the majority of current medical students. And the most of them would probably concur with his position.

As a woman in medicine, I find that accusation to be intellectually dishonest and cheap. You can debate the issue on its merits without resorting to baselessly accusing the “other side” of engaging in some kind of sexism because they happen to disagree with you.

I assure you that I and most other physicans and medical students would feel similarly about a doctoral physician assistant degree, a field in which at least half are male.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/04/my-take-dr-nurses-supporting-universal.html/comment-page-1#comment-84747 Anonymous Thu, 03 Apr 2008 02:06:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-dr-nurses-supporting-universal-care.html#comment-84747 I work with NPs every single day (at a nursing home caring for patients with 5 different chronic conditions on 10 different meds).<br/><br/>And every single day i marvel at the disparity between doctors and nurses in level (& type) of training.<br/><br/>Today one of the NPs ordered a dermatology referral for an ecchymosis (ie. bruise). The patient wasn't on coumadin, aspirin, or plavix - but that part wasn't even addressed in the note. In fact, NOTHING was addressed except the need for a derm referral. <br/><br/>Oh yeah, and the HbA1c was documented, as 9.8%. Of course, nothing was done about that part. Not even a referral to an actual doctor. I work with NPs every single day (at a nursing home caring for patients with 5 different chronic conditions on 10 different meds).

And every single day i marvel at the disparity between doctors and nurses in level (& type) of training.

Today one of the NPs ordered a dermatology referral for an ecchymosis (ie. bruise). The patient wasn’t on coumadin, aspirin, or plavix – but that part wasn’t even addressed in the note. In fact, NOTHING was addressed except the need for a derm referral.

Oh yeah, and the HbA1c was documented, as 9.8%. Of course, nothing was done about that part. Not even a referral to an actual doctor.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/04/my-take-dr-nurses-supporting-universal.html/comment-page-1#comment-84746 Anonymous Thu, 03 Apr 2008 01:56:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-dr-nurses-supporting-universal-care.html#comment-84746 Well again, Annie, I would ask: with the existence of PhD, EdD and DNSc doctoral degrees availble to nurses, what additional need is being served by the DNP degree that the other degrees cannot address? They all lead to doctorally-prepared nurses capable of serving as faculty and anyone with common sense will realize that the PhD in nursing is far better preparation for research. Why not expand these programs rather than create a new degree targeting nurse practitioners? Any nurse practitioner presumably holds at least a BSN and likely an MSN and is thus eligible to enter existing programs for any of those degrees. Well again, Annie, I would ask: with the existence of PhD, EdD and DNSc doctoral degrees availble to nurses, what additional need is being served by the DNP degree that the other degrees cannot address? They all lead to doctorally-prepared nurses capable of serving as faculty and anyone with common sense will realize that the PhD in nursing is far better preparation for research. Why not expand these programs rather than create a new degree targeting nurse practitioners? Any nurse practitioner presumably holds at least a BSN and likely an MSN and is thus eligible to enter existing programs for any of those degrees.

]]> By: The Happy Hospitalist http://www.kevinmd.com/blog/2008/04/my-take-dr-nurses-supporting-universal.html/comment-page-1#comment-84745 The Happy Hospitalist Thu, 03 Apr 2008 01:19:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-dr-nurses-supporting-universal-care.html#comment-84745 Dan, as you say:<br/>"Specifically, how does one objectively measure rigor? And for the sake of argument...even if that is "fact," why do you equate rigor and length with quality?"<br/><br/>Take 100 people, have all of them get a 4 year nursing degree. Then, have them all get their Nurse Practioner degree or get their degree in PA school. Then, when they all have their degrees, have them start medical school.<br/><br/>Rigor is defined by 100 people realizing that inspite of all their advanced degrees, they realize in their first week of med school that they are starting from square one, with an enormous black hole of understanding of the human body. And it will take 4 years of medical school and 3-7 years of residency before they even begin to understand.<br/><br/>That is how you will get your definition of rigorous. Dan, as you say:
“Specifically, how does one objectively measure rigor? And for the sake of argument…even if that is “fact,” why do you equate rigor and length with quality?”

Take 100 people, have all of them get a 4 year nursing degree. Then, have them all get their Nurse Practioner degree or get their degree in PA school. Then, when they all have their degrees, have them start medical school.

Rigor is defined by 100 people realizing that inspite of all their advanced degrees, they realize in their first week of med school that they are starting from square one, with an enormous black hole of understanding of the human body. And it will take 4 years of medical school and 3-7 years of residency before they even begin to understand.

That is how you will get your definition of rigorous.

]]> By: Paul http://www.kevinmd.com/blog/2008/04/my-take-dr-nurses-supporting-universal.html/comment-page-1#comment-84744 Paul Thu, 03 Apr 2008 00:44:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-dr-nurses-supporting-universal-care.html#comment-84744 Let's see, we've all been "providers" for years with no distinction in training etc. Now the NPs can actually call themselves "Doctor." Poor PAs, guess that leaves them out in the cold.<br/><br/>I SUPPORT universal health care without private insurance companies that pull $100 BILLION from healthcare every year. Let’s see, we’ve all been “providers” for years with no distinction in training etc. Now the NPs can actually call themselves “Doctor.” Poor PAs, guess that leaves them out in the cold.

I SUPPORT universal health care without private insurance companies that pull $100 BILLION from healthcare every year.

]]> By: Annie http://www.kevinmd.com/blog/2008/04/my-take-dr-nurses-supporting-universal.html/comment-page-1#comment-84740 Annie Thu, 03 Apr 2008 00:16:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-dr-nurses-supporting-universal-care.html#comment-84740 Re: providing clinical nursing care and the need for more nurses to be educated at the doctoral level, see this <a HREF="http://revolutionredux.wordpress.com/2008/04/02/wall-street-journal-shows-its-backside/" REL="nofollow">post</a>. Unlike Kevin and the WSJ posts, it is fact-based, sourced apropriately and addresses the underlying need for doctorally educated nurses.<br/><br/>If the uninformed public continues to demonstrate such disrespect for nurses, the question of who will be left to care for nurses is spot on. No one in their right mind will, surely. Re: providing clinical nursing care and the need for more nurses to be educated at the doctoral level, see this post. Unlike Kevin and the WSJ posts, it is fact-based, sourced apropriately and addresses the underlying need for doctorally educated nurses.

If the uninformed public continues to demonstrate such disrespect for nurses, the question of who will be left to care for nurses is spot on. No one in their right mind will, surely.

]]> By: savvydoc http://www.kevinmd.com/blog/2008/04/my-take-dr-nurses-supporting-universal.html/comment-page-1#comment-84739 savvydoc Wed, 02 Apr 2008 23:58:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-dr-nurses-supporting-universal-care.html#comment-84739 SavvyDoc.... Kevin you are absolutely right that universal health care does nothing if costs continue to go out of control. The system can absorb a small percentage of uninsured patients but that percentage is growing rapidly due to the incredible cost of care. <br/><br/>http://savvydoc.wordpress.com/2008/03/26/savvydoc-easy-doctors-appointments-online/ SavvyDoc…. Kevin you are absolutely right that universal health care does nothing if costs continue to go out of control. The system can absorb a small percentage of uninsured patients but that percentage is growing rapidly due to the incredible cost of care.

http://savvydoc.wordpress.com/2008/03/26/savvydoc-easy-doctors-appointments-online/

]]>