Political Correctness and Terminology

[JPINFV]

If you have this preconceived notion that NPs do not know the difference between an MD and their profession I suggest you do a little more research and shadow NPs in various work areas. I also suggest you find out what they do know and what purposes they do serve. Also, if you are not for the advancement of a profession by education, you might want to stick with EMS. Other professions understand that medicine is evolving and it takes a lot of education, ambition and innovative thinking for the future of health care to stay viable.

Oh, I have no doubt that people like Mary Mundinger know the difference between DNP and physicians. I also have no doubt that she's also actively trying to blur that line. Let's take a few lines from this Noctor. http://www.cnn.com/video/#/video/health/2010/04/17/nr.velshi.nurses.power.cnn

Well, the ultimate difference between nurses and physicians is the philosophy of care that is provided. My background is in nursing, and so I really take a holistic point to taking care of patients. Of course I want to take care of their physical needs and you know treat their hypertension and their asthma, but it's very important to me to understand how that diagnosis effects their emotional state and their spiritual state. So I'm looking at the whole patient from that aspect as a nurse.

Yes... because doctors are just pill popping machines who act like mechanic fixing a machine.

Nurse practitioners in family practice should be allowed to bill independently and get reimbursed.

Make no mistake. It's not that noctors don't know the difference. They just don't care.

It is also fairly easy to see where JPINFV, whose label is EMT-B/Med Student, lands when it comes to respect for other professions, especially nursing, when or if he even finishes med school. He will have to learn how to interact with many different professionals with many different education levels. Going against a profession for obtaining a higher education level or advancing professional status is not one that has the best interests of patients in mind. An an EMT he probably has also argued against advancing to even the Paramedic level because that could erode the cause for EMTs and the creation of more Paragods.

Oh.... I get it. Doctors and medical students, by default, hate everyone except other physicians. Sorry, but going against other professions who are demanding parity to other providers who they haven't reached yet is exactly what you're saying I'm not doing. Protecting patients.

Heck... let's take a quick Duke's DNP program.

http://nursing.duke.edu/wysiwyg/downloads/Sample_Post_BSN_DNP_Adult_MAT_Plan.pdf

First thing, please notice that this is a full time distance learning program. Ok, next 38 credits on nursing theory vs only 18 in actually treating patients. Hmm... Do you really want to go see someone who's only learned "select topics in advanced pathophysiology?" What happens if your problem isn't one of those select topics? See... maybe I'm against the idea of I have more units in a single semester on clinically relevant information than the noctors have in their entire program. Heck, the neuroscience system (anatomy, physiology, pathology, pharmacology, and clinical instruction) only was 11 units.

Edited May 6, 2010 by JPINFV

[JayEMTP]

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

You brought up your own ludicrous examples of nutty NPs and LPNs writing prescriptions. You still have no understanding of what a Nurse Practitioner is. You have no understanding of the differences of titles between a doctor as used for someone who has a doctorate, a DNP, a DPT, a Ph.D. and a Medical Doctor as it pertains to scope of practice. If you dislike the Nurse Practitioner as a Physician Extender, why would you even consider entering in the profession? You seem to only have negative examples (all 2 of them) of anyone with higher education like a DNP. Again, you would not be doing nurses or NPs any favor if you just want to drag them down because you are against them holding a doctorate degree just based on a couple of NPs that you think "want to be doctors".

You also try to justify your thoughts and sticking up for each other since high school? Haven't you progressed at all past that to have your own thoughts without seeking approval from a high school bud or being afraid you might offend someone on this forum if your present an original thought? I don't know paramedicmike but I do know the comments in your post and the one he made. Advanced education seems to strike a nerve with him. It is hard to tell if he was pro education or against it and your post definitely did not read of one who was a big education advocate.

I will remind you again, very few people are going to search through thousands of posts to find that one you agreed with education. The search engines pull up the first page and that is what the public sees on an open forum. You are on an open public forum where your views are there for all to see. Anyone can log on and post comments. However, when someone does, you take offense if they are not in agreement with you and everyone should know exactly how you feel and who you have known since high school. Some then feel they need to rally the herd and chase off someone who might disagree or bring in a different thought such as education. Maybe you should have a closed forum so the public doesn't have to see the views on this forum. Some of the threads and the posts they contain are not very flattering for EMS.

Have a nice life but do consider seeking another profession other than nursing and definitely not NP. You would have to obtain a doctorate degree and you wouldn't want that. You would then be one of those nutty NPs who have a DNP and we all know how stupid they are as you just pointed out with all of your examples.

[Eydawn]

Never mind! You're just a prick! LOL. Wow.

Again, you infer things that are not there. I know a couple of DNPs who shouldn't be. I know DNPs who are awesome, as well. You seem to only highlight that which agrees with your original, mistaken perceptions... I did not imply that I find the NP/DNP to be an inadequate physician extender, either. Nor did I imply that I would discourage anyone from pursuing a doctorate in any given field. Do you actually READ? I mean... seriously.

My post did not read like that of an education advocate? Did you READ the second post where I laid out my views on education? And it's generally considered good form, before attacking someone, to go to their profile and read "posts by user." This does not involve more than a modicum of effort... apparently that's too much for someone like you, because you know everything about everyone! WOW!

I did not go to high school with Paramedicmike. Way to make another mistaken assumption. I befriended him when *I* was 17. He is much older and far more experienced than I am. I am now 24. 17 + 7 = 24... I do not rely on anyone to back me up, nor do I need to "rally the herd"... I have stood apart from the masses for most of my life, and I intend to continue doing so.

I begin to smell a troll... *sniff*... Snrk!

Wendy

CO EMT-B

[JPINFV]

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.

Err... I'm not thinking about being an NP. Try again. Also, being the husband of a NP doesn't make you an expert on NPs either. Also, if you've seriously browsed this and other forums, you'd notice that I (for the record, I'm "JPINFV" on most forums) don't exactly have a great deal of respect for the requirements to be an EMT either, little less the requirements to become a paramedic.

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.

When the noctor walks in and says, "Hi, I'm Doctor Noctor," are you going to seriously say that patients aren't going to assume that the person has an unrestricted license to practice medicine? Sorry, the term "doctor" in health care settings should be reserved for those with independent practice rights and everyone should take pains to avoid confusion. I would argue that a physician in a dentist office shouldn't be introducing themselves as "doctor" either because that setting a "doctor" is the dentist. Similarly, unless providing dental care, dentists shouldn't be using the term doctor in the hospital.

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.

If not, then why do they insist on being called doctors then?

[emtannie]

I also stated U.S. in my earlier comments…

You also stated “anywhere” which, this being a global site, I wanted to comment on.

I am also not being argumentative but merely stating facts.

You are being argumentative in that in earlier posts, you made gross generalizations, and accused others of doing the same.

You are twisting my words… I did not say “EMS was not around 40 years ago.”

Again, let’s take a look at what I DID say: 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.

I will stand corrected on my statement “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” and appreciate the links and references you posted; however, you completely discounted the rest of my statement that we have increased standards, and have chosen to twist my words. And, I will repeat my last sentence from the previous post “you choose to be argumentative rather than read my post clearly, and try to have a discussion rather than an argument.”

I will post this question to you: Do you feel that the associate degrees of the 1970’s are the equivalent to the associate degrees offered today? Do they cover the same material to the same depth as today? Are those who graduated from the program in 1970 as educated and skilled as those today?

My answer to those questions is no. With improvements in equipment, monitoring procedures, and medication administration, and increased knowledge in the effect of our interventions, I think that students today are more educated and more skilled than those who graduated 40 years ago. This then goes back to my comment that we DO have increased standards.

… comments which you took personally…

I requested clarification, and apologized if I misunderstood. I don’t see great emotion in that, and I do not worry about my perceived image on this forum. I present myself as I see fit, and if you or someone else doesn’t agree, I do not lose sleep over it. My personal self-worth is not tied to this website. Do not talk down to me – you are not greater than I am. I will treat you as an equal if you treat me as one. I will disagree with people on this site at times, and have, even with those whom I have developed friendships with, both on and off this site. Do not lower yourself to trying to belittle me and my opinion of myself as part of your attempt at argument. By personally attacking me with the comment “So how can I even provide a reasonable argument to you without your emotional response to protect your perceived image on this forum?” I refuse to respect your opinions. I have not attacked you personally, but specifically discussed points of your posts.

I have asked you to read more of the posts on this site, and to look at some of the well-thought-out, educated posts that have been made, but you appear to want to focus on the lower quality posts. Again, all I ask is that you do not generalize all posters in that category. Please review the categories “Instructors” and “Students” in the forums to begin with, and I suspect they will lead you to some posters that you can follow from there.

[JayEMTP]

First thing, please notice that this is a full time distance learning program. Ok, next 38 credits on nursing theory vs only 18 in actually treating patients. Hmm... Do you really want to go see someone who's only learned "select topics in advanced pathophysiology?" What happens if your problem isn't one of those select topics? See... maybe I'm against the idea of I have more units in a single semester on clinically relevant information than the noctors have in their entire program. Heck, the neuroscience system (anatomy, physiology, pathology, pharmacology, and clinical instruction) only was 11 units.

Welcome to the computer age. Many classes can be taken online at undergrad and graduate level. Even the EMT and Paramedic courses are now online. Of course the practical/clinical part is generally in person.

You fail to count the undergraduate and graduate courses required in the sciences. Even the ADN requires more than 11 units in the sciences.

Why don't you just post the complete link to Duke's nursing programs?

I'll just do that for you since you may have obtained the other link by a random search and not through the nursing program site.

http://nursing.duke.edu/

Pathways to DNP at Duke:

http://nursing.duke.edu/modules/son_academic/index.php?id=110

If not, then why do they insist on being called doctors then?

How many NPs have you actually met? Are you also trying to be like your fellow forum member here with her examples of all the NPs she knows and all seem not to be worthy to be called much of anything least of all nurses?

And this is not my quote:

Well, the ultimate difference between nurses and physicians is the philosophy of care that is provided. My background is in nursing, and so I really take a holistic point to taking care of patients. Of course I want to take care of their physical needs and you know treat their hypertension and their asthma, but it's very important to me to understand how that diagnosis effects their emotional state and their spiritual state. So I'm looking at the whole patient from that aspect as a nurse.

And now for the emotional name calling (credit to Eydawn) which is probably associated with one of the "generalizations" I made earlier and someone had to prove it to be true once again.

It also seems that when someone talks about education and nurses they get labeled as a troll. What troll would spend (probably waste) as much time as I have to enlighten you about NPs and the history of EMS? If being an advocate for higher education and giving some more information about other medical professionals makes me a troll in the eyes of EMS providers then I guess little will ever change.

[JPINFV]

Welcome to the computer age. Many classes can be taken online at undergrad and graduate level. Even the EMT and Paramedic courses are now online. Of course the practical/clinical part is generally in person.

There's a difference between a class being online and an entire program. There's something to be said about being in close proximity to school and the support services offered. There's also something to be said about having the choice to attend lectures in person. There's also something to be said about exam security that you can't say on any take home exam.

You fail to count the undergraduate and graduate courses required in the sciences. Even the ADN requires more than 11 units in the sciences.

Oh, please. There's a big difference between general undergrad courses and professional level graduate courses. My upper division undergrad neurobio course wasn't anywhere close to the level of difficulty and the quantity of material covered in the neuroscience system.

Why don't you just post the complete link to Duke's nursing programs?

I'll just do that for you since you may have obtained the other link by a random search and not through the nursing program site.

http://nursing.duke.edu/

Pathways to DNP at Duke:

http://nursing.duke.edu/modules/son_academic/index.php?id=110

I link directly to what I reference so that people reading the link don't have to go searching around a website for the evidence that I'm using to support my arguments.

Of course you aren't refruting that Duke's DNP program is high on fluff and low on substance... interesting.

And this is not my quote:

Reread my post. I never claimed it was your quote. I very specifically said that it was a quote from the noctor being interviewed in the video I linked.

[JayEMTP]

I will post this question to you: Do you feel that the associate degrees of the 1970's are the equivalent to the associate degrees offered today? Do they cover the same material to the same depth as today? Are those who graduated from the program in 1970 as educated and skilled as those today?

My answer to those questions is no. With improvements in equipment, monitoring procedures, and medication administration, and increased knowledge in the effect of our interventions, I think that students today are more educated and more skilled than those who graduated 40 years ago. This then goes back to my comment that we DO have increased standards.

The United States' Associates degrees for EMS were better in the 1970s since they used the same Anatomy and Physiology, pharmacology and pathophysiology classes as the RNs. Paramedics also did more invasive skills routinely in the 1970s than they do today on regular ground EMS although that is largely due to evidenced based medicine and necessity. There were pericardiocentesis, intracardiac epi, chest tubes and central line placement such as subclavians in use. Now the degrees have been watered down with survey courses for Anatomy & Physiology and pharmacology. Protocols have been streamlined to meet the lowest denomonator of whatever patch which isn't flattering. If you want examples just read the headline makers on the front page of this forum now.

Even the old mainstay of ETI is taking the back seat to alternative airways. Many of the new grad Paramedics on another forum noted they have yet to intubate a human. The cardiac monitors way back when also required the Paramedics to know the rhythm rather than having the machine tell them.

I link directly to what I reference so that people reading the link don't have to go searching around a website for the evidence that I'm using to support my arguments.

Of course you aren't refruting that Duke's DNP program is high on fluff and low on substance... interesting.

I linked to the full programs including NP with the necessary prerequisites and not just a selective link once those have been acquired.

[akflightmedic]

Hmmmmm....

Argumentative...check

Expert use of quotations...check

Superiority complex....check

Comments displaying prior knowledge of longtime posters...check

IP matching...check

Welcome Back Vent...despite your threats you never stay gone.

[JPINFV]

I linked to the full programs including NP with the necessary prerequisites and not just a selective link once those have been acquired.

Academic pre-reqs: Essentially a BSN

Dukes BSN program:

http://nursing.duke.edu/modules/son_academic/index.php?id=2

Course work:

Again, high on fluff, low on actual background. Now, yes, the prereqs includes some missing courses, but let you ask yourself this. If undergrad A/P was so useful for independent practitioners, why is it that no medical school in the US requires A/P as an admissions requirement and instead teaches it in-house? Where's the chemistry requirement? Physics?

Hmmmmm....

Argumentative...check

Expert use of quotations...check

Superiority complex....check

Comments displaying prior knowledge of longtime posters...check

IP matching...check

Welcome Back Vent...despite your threats you never stay gone.

Hey Eydawn, didn't I call this over IMs?

Edited May 6, 2010 by JPINFV