Political Correctness and Terminology

[chbare]

I have to disagree. There is a big movement and in some states NP's already have completely independent practice. In addition, there is a group of NP's who want to be called doctor in the clinical setting and utilise the doctor nurse practitioner concept as a means of doing so. While we are veering off topic, it is important to realise this movement is actually worthy of a discussion on the terminology behind how we address providers in a clinical setting.

Regarding the OP, I do not see how using these pet terms to describe people in casual conversation can be all that harmful. Clearly, bullying and such occurs in our profession; however, these terms are far from the worst problems we encounter regarding terminology, respect, professionalism and bullying.

Take care,

chbare.

[paramedicmike]

Hey JayEMTP,

I suggest you spend a little more time perusing the forums and getting to know the people here before bashing a rather established and respected member of this community with your own demonstrated ignorance. It might save you some trouble in the long run.

[JayEMTP]

I have to disagree. There is a big movement and in some states NP's already have completely independent practice. In addition, there is a group of NP's who want to be called doctor in the clinical setting and utilise the doctor nurse practitioner concept as a means of doing so. While we are veering off topic, it is important to realise this movement is actually worthy of a discussion on the terminology behind how we address providers in a clinical setting.

NPs are not raising their education standards just to be called doctor. NPs will be raising their entry education level to doctorate in 2015. This process started over 10 years ago and it will be 15 years by the time 2015 comes. This was not a concept just thought up yesterday. With the demands of health care and the pressure to show a profession is worthy of reimbursement, higher education is becoming a necessity. Medicine continues to evolve and that requires a commitment of those involved in health care to see their profession keeps pace with the changes or has the knowledge resources to seek out what they don't know.

About NPs:

http://www.aanp.org/AANPCMS2/AboutAANP/About+NPs.htm

http://www.aanp.org/AANPCMS2

If it takes the NP profession over 15 years to achieve a doctorate for their entry level from a Masters, how long do you think it will take EMS to accept anything above a certificate for Paramedic in the U.S.? Right now the opposition against NPs advancing education comes from a few who feel threatened by a title and aren't seeing much past that. The NPs in the profession are not opposing the change because it is long past due for them to increase their level. However, in EMS opposition to change come from within the profession.

Hey JayEMTP,

I suggest you spend a little more time perusing the forums and getting to know the people here before bashing a rather established and respected member of this community with your own demonstrated ignorance. It might save you some trouble in the long run.

This is a typical and expected response from an EMS forum.

You can't see past what has always been said or done and that is the way EMS will always be. No sight for the future.

Those who bash education and nurses will always be placed on a higher pedestal on these forums.

[emtannie]

This is a typical and expected response from an EMS forum.

You can't see past what has always been said or done and that is the way EMS will always be. No sight for the future.

Those who bash education and nurses will always be placed on a higher pedestal on these forums.

Wow - I am happy to see that this topic has veered to something worth discussing, however, JayEMTP, I do agree with paramedicmike. You have 3 posts on this site, 2 in the last 24 hours, and have only been a member here for 2 weeks. You have already chosen to make gross generalizations and be insulting to members who have had well-educated and thought out posts.

If you would read the posts carefully, no one was bashing nurses in general, or NP's in general, but were questioning why certain individuals want to work outside medical direction and think they should have a larger scope of practice. Other posters pointed out that there are those practitioners who love their title, but do not have the common sense that should go with it.

No one singled out your wife, and yes, she should be called Doctor as she holds a Ph.D.; however, she should not be called "doctor" in the setting of medical doctor with the scope of practice allowed for doctors. That is what the discussion was about. There are NP's, and those who use the term DNP's, who wish to be called doctor as though they work with the same scope of practice as a medical doctor, not referring to whether they have a Ph.D. or not.

Your knee-jerk responses to the posts here show that you haven't truly read the posts. Your comment "typical and expected response from an EMS forum" is offensive, as you have chosen to insult those who post here, without truly reading and understanding the thread.

"You can't see past what has always been said or done and that is the way EMS will always be. No sight for the future." Again, if you would spend more time in the forums, you will find many threads, and thousands of posts where EMS practitioners are fighting for more education and higher standards, both locally and nationally. Your gross generalization is a slap in the face to those of us who are trying to make positive changes in this profession, and as a member of this profession, your comment shows that you are the uneducated one, as you think we have not advanced from the "ambulance drivers" of the 1970's.

"Those who bash education and nurses will always be placed on a higher pedestal on these forums." Please provide proof of this other than posts which are posted in the Funny Stuff section. People bash SPECIFIC nurses who deserve to be bashed due to their actions and lack of knowledge. As a whole, we DO NOT bash the nursing profession, and again, you have made a gross generalization.

In a previous post, you said "EMS does differentiate their female medics and usually divides them into two categories but I seriously doubt if you would like to hear either one.' I would be interested, and yes, I would like to hear, and if you prefer not to post publicly, you can use the pm option. I was a commercial bank manager for many years, and the only female in a very large region - from what I have seen in 14 years in EMS, EMS certainly does not have a monopoly on derogatory comments towards women who can do the job as well as men. So feel free to enlighten me.

And, before you make comments about "EMS hasn't raised its education standards in over 40 years so there is little for those here to compare to understand the process, the gains and even a few losses that may go with increased responsibility or liability" please review the credentials of many who post here. Since I know you will want to know my background, I have both a B.Sc. and a B.Econ, and am currently working on my BHS (Bachelor of Health Sciences). I am an instructor at 2 colleges, and work on curriculum development. We are working to make the minimum standard NOT just an Associates degree, but a bachelor's degree. Within the next two years, I plan on starting my M.Sc, all while working full time on car, instructing, and running my own business. Please don't confuse me with someone who isn't spending time in this field or someone who is not trying to improve education standards.

[JayEMTP]

Wow - I am happy to see that this topic has veered to something worth discussing, however, JayEMTP, I do agree with paramedicmike. You have 3 posts on this site, 2 in the last 24 hours, and have only been a member here for 2 weeks. You have already chosen to make gross generalizations and be insulting to members who have had well-educated and thought out posts.

If you would read the posts carefully, no one was bashing nurses in general, or NP's in general, but were questioning why certain individuals want to work outside medical direction and think they should have a larger scope of practice. Other posters pointed out that there are those practitioners who love their title, but do not have the common sense that should go with it.

No one singled out your wife, and yes, she should be called Doctor as she holds a Ph.D.; however, she should not be called "doctor" in the setting of medical doctor with the scope of practice allowed for doctors. That is what the discussion was about. There are NP's, and those who use the term DNP's, who wish to be called doctor as though they work with the same scope of practice as a medical doctor, not referring to whether they have a Ph.D. or not.

Your knee-jerk responses to the posts here show that you haven't truly read the posts. Your comment "typical and expected response from an EMS forum" is offensive, as you have chosen to insult those who post here, without truly reading and understanding the thread.

"You can't see past what has always been said or done and that is the way EMS will always be. No sight for the future." Again, if you would spend more time in the forums, you will find many threads, and thousands of posts where EMS practitioners are fighting for more education and higher standards, both locally and nationally. Your gross generalization is a slap in the face to those of us who are trying to make positive changes in this profession, and as a member of this profession, your comment shows that you are the uneducated one, as you think we have not advanced from the "ambulance drivers" of the 1970's.

"Those who bash education and nurses will always be placed on a higher pedestal on these forums." Please provide proof of this other than posts which are posted in the Funny Stuff section. People bash SPECIFIC nurses who deserve to be bashed due to their actions and lack of knowledge. As a whole, we DO NOT bash the nursing profession, and again, you have made a gross generalization.

In a previous post, you said "EMS does differentiate their female medics and usually divides them into two categories but I seriously doubt if you would like to hear either one.' I would be interested, and yes, I would like to hear, and if you prefer not to post publicly, you can use the pm option. I was a commercial bank manager for many years, and the only female in a very large region - from what I have seen in 14 years in EMS, EMS certainly does not have a monopoly on derogatory comments towards women who can do the job as well as men. So feel free to enlighten me.

And, before you make comments about "EMS hasn't raised its education standards in over 40 years so there is little for those here to compare to understand the process, the gains and even a few losses that may go with increased responsibility or liability" please review the credentials of many who post here. Since I know you will want to know my background, I have both a B.Sc. and a B.Econ, and am currently working on my BHS (Bachelor of Health Sciences). I am an instructor at 2 colleges, and work on curriculum development. We are working to make the minimum standard NOT just an Associates degree, but a bachelor's degree. Within the next two years, I plan on starting my M.Sc, all while working full time on car, instructing, and running my own business. Please don't confuse me with someone who isn't spending time in this field or someone who is not trying to improve education standards.

I don't care how many posts this person has or how long they have been on this forum. Does that make this person an expert about being an NP? This person is an EMT-B who is thinking about becoming an NP but doesn't like what the profession is about because of the word doctor for someone who has obtained a doctorate degree.

My response is offensive because it is different than what has been posted here. I didn't call anyone a Firemonkey. I didn't have anything bad to say about NPs and I didn't praise EMTs as the only important level in EMS.

I have read through some of the threads on this forum and a few others. I am appalled by the number of people who will fight against any change in education for EMS. It seems there is more of a struggle to just get EMS providers to meet the minimal standards as they are now.

Now for a little education to you about your own profession. Ambulance Drivers in the 70s started to obtain an EMT-B cert. Ambulance drivers in the 1940s also could obtain basic first aid certs for ambulance and many had been military ambulance drivers. Today, the EMT-B still exists as a basic first aid cert. The Paramedic was developed in the 1960s initially by 2 FDs on opposite coasts and a hospital ambulance service in Pittsburgh. To this date, only a couple of states want a two year degree for entry and there are even exceptions to that requirement.

You need to back up your statement that the Bachelors is going to be made the minimal standard for EMS anywhere in the near future. Show me some legislation in the works. Show me some legislation that even the Associates is on some state's agenda for consideration as becoming the entry level mandate. The university in the city I am in does offer a Bachelors degree for EMS but they are very, very careful not to tell new students "it is required" to be a Paramedic. That would be a gross misrepresentation. They can tell the student it opens up more opportunities for them as a professional. You also fail to see that the doctorate will be an increase in minimal education for the NP. EMS providers still have the option to move to a state that has the least amount of hours of training to get their cert if a few more hours doesn't work for them.

Other professions have dealt with the use of terms as it pertains to higher education and it is not that difficult. If you are working an an EMT-B and happen to have a Ph.D. in education, are you going to tell your patient you are a doctor? If you use your Ph.D. to work in research would it not be appropriate to use the doctorate title rather then "EMT"? If you are a nurse who also holds a doctorate degree, would it not be appropriate to be called by your correct title in a university setting by your students? But, if this nurse also works in the ED as an RN, do you not think the appropriate title would be used for that setting regardless of the education listed on the name badge? Many people list their higher education on their name badge but don't insist on everyone using the title of "doctor" to address them. The doctorate is a form of higher education. Accept it and don't fight higher education for other professions that you probably have no idea of what their title and job description actually includes.

You are making assumptions about NPs that they just want to be called doctor to imply they are just like doctors. They know their scope of practice just like the reference earlier to the LPN writing a prescription. The LPN should know that is not within their scope of practice. Again don't make out all professions to be stupid. Granted, many Paramedics and even EMTs believe they are just like a doctor and will even say that when telling people what they do but that doesn't mean a whole profession should be crucified because of the "assumptions" made by a few on this EMS forum.

[emtannie]

You are deliberately being argumentative, and refusing to read my post clearly.

This person is an EMT-B who is thinking about becoming an NP but doesn't like what the profession is about because of the word doctor for someone who has obtained a doctorate degree.

My quote from my previous post: If you would read the posts carefully, no one was bashing nurses in general, or NP's in general, but were questioning why certain individuals want to work outside medical direction and think they should have a larger scope of practice. Other posters pointed out that there are those practitioners who love their title, but do not have the common sense that should go with it.

NOTE: my statement was not a gross generalization – yours was. You are attacking an individual without looking clearly at what they said. Their post specifically referred to a certain individual, not a profession in general.

I didn't call anyone a Firemonkey. I didn't have anything bad to say about NPs and I didn't praise EMTs as the only important level in EMS.

You appear to have directed this at me. Please show me where I have done the above. If I have misunderstood this as being directed at me, my apologies. If this is again a gross generalization, then I would recommend you specify who you are directing your comment to.

My response is offensive because it is different than what has been posted here

No, your response is offensive because it is a gross generalization, and shows that you have chosen to blatantly ignore posts in this site that argue for further education.

Now for a little education to you about your own profession.

If you would look back on your previous post, you said “"EMS hasn't raised its education standards in over 40 years so there is little for those here to compare to understand the process, the gains and even a few losses that may go with increased responsibility or liability"; my argument is that we HAVE raised education standards. There was no paramedic designation then, there were no advanced procedures done in the field, and there were no associates or bachelors degree programs as there are now. Again, you choose to be argumentative rather than read my post clearly, and try to have a discussion rather than an argument.

You need to back up your statement that the Bachelors is going to be made the minimal standard for EMS anywhere in the near future.

Oh yes, I should have informed you (since I suspect you haven’t done your research and looked at my profile, where I have provided my demographics - I notice you haven't), I am not in the USA, but in Canada. As you may have noticed, many here on this site feel that the American standards are inadequate and need to be improved and advanced. In the province of Alberta, several colleges are working with our provincial regulating body in making changes to increase minimum education standards. You are correct – many places in the USA do not feel that higher education is required; please give respect to those in your own country who are trying very hard to change that. A number of those are active members on this site. You may want to look at some of the Canadian standards, and those in NZ and Australia as well.

The doctorate is a form of higher education. Accept it and don't fight higher education for other professions that you probably have no idea of what their title and job description actually includes.

My quote from my previous post: There are NP's, and those who use the term DNP's, who wish to be called doctor as though they work with the same scope of practice as a medical doctor, not referring to whether they have a Ph.D. or not.

Once again, you have chosen to misinterpret my statement. I did not say that the doctorate is not a higher form of education. I also did not say that I am fighting higher education; in fact, I am always fighting FOR higher education. My argument is that there are SOME practitioners that feel that they should have the same scope of practice as a medical doctor, without the same (read equivalent) education. A doctorate and an MD are not the same education. Both are higher education, but not the same.

You are making assumptions about NPs that they just want to be called doctor to imply they are just like doctors.

My quote from my previous post: If you would read the posts carefully, no one was bashing nurses in general, or NP's in general, but were questioning why certain individuals want to work outside medical direction and think they should have a larger scope of practice. Other posters pointed out that there are those practitioners who love their title, but do not have the common sense that should go with it.

They gave specific examples about specific individuals, not generalizing an entire profession. My statement was not a gross generalization – yours was.

Granted, many Paramedics and even EMTs believe they are just like a doctor and will even say that when telling people what they do but that doesn't mean a whole profession should be crucified because of the "assumptions" made by a few on this EMS forum.

Ahh, on this we agree. There are medics who think they are gods, just as there are doctors and nurses and NP's, and LPN's, and DNP's who think they are gods. Every profession has those who think they are. Again, I ask that you go back, and look at the comments made. The references were regarding the FEW individuals who believe they are just like a doctor, not an entire profession.

[Eydawn]

I beg your pardon! I must bow to the master, since I obviously don't know any of my orifices from various geological formations! Good lord, man... you obviously don't know me at all to come at me so strongly. I wrote that post at the end of a *very* long night shift that was also interspersed with studying for a final exam for tomorrow. Too bad you missed my tongue in cheek... and I'll be very honest, the word "noctor" just tickled my funny bone. My apologies for having a sense of humor.

For your information, I already possess a Bachelor's degree. Nowhere did I imply that all Nurse Practitioners do not understand the delineation between an MD and a DNP. I am *very* familiar with the differences between PAs, MDs and NPs, having considered each of those options as a long term career goal. I am personally acquainted with several individuals who are PAs, MDs and NPs, respectively. I am also intimately familiar with a couple of individuals who possess a DNP who really and truly should never have obtained that licensure.

To counter another of your points, nowhere did I indicate that I have a problem with someone who has a doctorate degree being addressed as "doctor." What I do have a problem with is someone who possesses a doctorate degree in a health field attempting to represent themselves as equal to an M.D. which they are clearly not. NP and MD are very different practices, with different ethical focuses and treatment emphases. They may accomplish similar goals, but the educational path is drastically different and I feel that those differences need to be recognized. For those of us in the medical field this is not so difficult; for the layman, who stands to lose the most in this game, it is very easy to confuse. There are a select group of individuals who are attempting to represent themselves as equal to the M.D. in petitioning for completely autonomous practice, and I disagree with this. I believe that a physician extender, no matter how competent in their field, is NOT a doctor. If this offends you, I am sorry, and I would like to know why.

I have great respect for the vast variety of medical providers in modern medicine. I am in awe of what PTs can do. I admire those of my friends who have managed to make it through medical school, and have greatly enjoyed watching them develop both personally and professionally. I am immensely proud of my friends who have progressed to Paramedic (many of whom expand their knowledge at every possible opportunity.) Your comment about "piss poor opinion" of NPs is ludicrous, to say the least. I would really like to know how you gained that impression when I didn't really comment on the field of NP itself...

As far as advancement of education for medical professions goes, you will find no stronger advocate for higher level education than myself. I became very aware of the EMS education shortcomings very quickly. I realized that I had been turned loose with next to no education on pharmacology, anatomy and physiology, pathophysiology, and so forth... it made me very uncomfortable, and as I have moved away from the initial 'Hooyah I got a cert!' phase I have come to the conclusion that EMS providers should at the very least have an Associate's degree, preferably a Bachelor's degree, before they are allowed to practice at the level that they currently practice at. This opinion, in part, has been formed through the multiple intellectual discussions that have taken place in this forum. It has also been formed from my personal experiences in various aspects of EMS.

I am not nurse bashing (again, where the hell did you get that idea?); I recognize the shortcomings of EMS very acutely. Why, good sir, do you think I am pursuing a degree in nursing instead of EMS? To be fair, I also acknowledge the shortcomings that are present in the field of nursing. No profession is immune to failure. Nursing simply happens to be further along the "developed" continuum than prehospital care, as far as I can see. I also much prefer nursing ethics and the nursing approach to care. I intend to obtain my BSN as soon as practically possible, as I feel the ADN will not be adequate for my goals, even though it allows me to license as an RN.

You know what I think you did? You saw that "EMT-B" after my name and lumped me in with the "we don't need no stinkin' degrees" crowd without even bothering to go through any of my posts to get a feel for who I really am and how I *really* think. You chose to judge me based on a single post without context.

Shame on you.

For someone who appears to be so intelligent, based simply on the quality of your writing, that was a pretty ignorant move.

And for the record: Paramedicmike has known me since I was 17. That would be nearly 7 years at this point. He knows that I am not in any way anti-education, and was trying to gently clue you in. For you to lump him into that same ignorant mental mold was another ridiculous move.

Yes, there are those who oppose education advancement on this forum. If you spend some time actually reading threads, you will see that those who advocate education are as vociferous as their ignorant counterparts (and generally spell better, to boot!)

As far as the LPNs writing prescriptions, not a *single one* actually wrote a prescription. This NP in question sought advice on how to write the prescription, to the very drug and dosages, from our LPNs. This was deemed wholly ludicrous, and discredited this NP in the eyes of everyone who has become aware of these incidents (yes, they are plural).

Stupidity is not limited to a profession. I think that's where I'll leave this for now.

Wendy

CO EMT-B

[JayEMTP]

If you would look back on your previous post, you said ""EMS hasn't raised its education standards in over 40 years so there is little for those here to compare to understand the process, the gains and even a few losses that may go with increased responsibility or liability"; my argument is that we HAVE raised education standards. There was no paramedic designation then, there were no advanced procedures done in the field, and there were no associates or bachelors degree programs as there are now. Again, you choose to be argumentative rather than read my post clearly, and try to have a discussion rather than an argument.

Let's just concentrate on this since it is obvious that the NP is not appropriate for this forum.

I also stated U.S. in my earlier comments. The NP being discussed was also in the U.S. I thought you knew this or had at least read it since I did state that and posted links to the AANP (American Academy of NPs)

I am also not being argumentative but merely stating facts. You can check all the facts on the internet at fairly reliable sources such as the EMS Museum.

Freedom House Paramedics were established in 1968 with advanced procedures. Do the math. That is more than 40 years ago.

By 1969, Paramedics were working with advanced equipment doing advance procedures in Marietta, GA.

The AAOS textbook came out in 1969 for EMTs.

1969 - Miami establishes its Paramedic program.

The TV show "Emergency" came out in 1972. The show did not come out first and then the idea of a Paramedic. That was over 38 years ago.

EMS degrees at the Associates level were established in the 1970s but it never evolved as a popular concept when the certificate was available and very easy to do for entry into EMS. The Paramedic is still a certificate today and the hours of training has not increased very much over the past 40 years in all but a couple of states. I also already mentioned that there are exceptions in those states.

In 1970, the EMT-B was approximately 110 hours and it is still 110 hours in many states.

If you consider posting facts to contradict your statements about EMS not being around 40 years ago as being argumentative then I guess I am. If you consider me correcting you that the U.S. does not require a Bachelors degree for entry as a Paramedic as being argumentative, then I guess I am. You asked if I read the posts on this forum and I stated some of the things I saw like Firemonkey comments which you took personally. So how can I even provide a reasonable argument to you without your emotional response to protect your perceived image on this forum? I am not about to read through thousands of posts to find a few that pertain to education. This thread appears now and the current posts are in the present. These will be what anyone will see who stumbles upon this forum by accident as I did a few weeks ago. If you want to bring in other threads to support the arguments here, then link to them. Right now I don't care what somebody posted 5 years ago and they may not even remember what the posted. I also saw where old threads are even discouraged from being brought back because they are no longer relevant.

[Richard B the EMT]

I asked before on a different string, which went unanswered. I'll ask again, here and now:

What the heck is a "Noctor"?

[Eydawn]

It's a humorous word smash. Nurse-doctor = "Noctor"