Nurses know medicine like air hostesses know aviation

pharmaton

Rasheed wrote: »

Op now I think you're just trying to get a rise out of people.

Ok what did I my four years in college, two years part time in college and five years experience in an acute hospital setting get me? What would you consider me actually qualified in or what do you think I could give advise on?

Making a tidy bed?
Giving a right good bed bath?
Filling a uniform well?

don't forget making the man doctors tea.

jr22

Jimoslimos wrote: »

Actually there are plenty of studies on evaluating whether there are any differences in patient outcome (as well as financial feasibility) between nurse-practitioner led primary care and physicians or combinations of the two
http://www.ncbi.nlm.nih.gov/pubmed/16390522
http://www.ncbi.nlm.nih.gov/pubmed/14706124
http://www.ncbi.nlm.nih.gov/pubmed/10632281

Oh, and since you mention The Lancet,
http://www.ncbi.nlm.nih.gov/pubmed/10533859



I think I may need a linguistics degree to decipher some of your posts, toppers?

Two UK and two US studies, the oldest 15 years old and the most recent 7 years old. No Irish study. That's what I'd be interested in.

It would be difficult to compare the HSE to the NHS without the HSE coming up short. I can't see how very specific study of an A&E dept in Sheffield or nursing homes in Texas could generalise to a very different Irish context. I don't have experience or knowledge of the US health system but I know it's very different from here.

The Sheffield study finds (non-junior) nurses can provide the same level of care on minor injuries as junior doctors. Not too surprising.

The London study find the standard of care provided by nurse-led practitioners to be acceptable in the majority of cases:eek: but not equal to that doctors.

Quote While the results of the study suggest that ANNPs do not perform as well as medical staff, in the majority of cases, they still performed to an acceptable standard.

Now, if I had a premature baby, I'd sure as feck hope that my kid was assigned to the doctor in this instance, and not met with the dodgy care of a nurse-led practitioner who in this study often didn't reach an acceptable standard of practise.

Financial feasibility is the driver of nurse led practitioner care. It's a money saving exercise, in the same way that classroom assistants fill in for qualified teachers in the UK during planning time. It's cost cutting, pure and simple. Less qualified people are drafted into to do as much of the work of a superior that is practicable without any legal repercussions.

In the long run, patients lose out on the expertise of someone with superior training who isn't struggling to punch above their weight.

Jimoslimos wrote: »

I think I may need a linguistics degree to decipher some of your posts, toppers?

You've never heard this?

http://www.slang.ie/index.php?county=Tipperary&entry=TOPPER

Jimoslimos

jr22 wrote: »

Now, if I had a premature baby, I'd sure as feck hope that my kid was assigned to the doctor in this instance, and not met with the dodgy care of a nurse-led practitioner who in this study often didn't reach an acceptable standard of practise.

Fallacy: Appeal to emotion.

Often? Did you read what you just wrote

jr22 wrote: »

The London study find the standard of care provided by nurse-led practitioners to be acceptable in the majority of cases:eek: but not equal to that doctors.

While the results of the study suggest that ANNPs do not perform as well as medical staff, in the majority of cases, they still performed to an acceptable standard.

I note you conveniently omitted to include the bit about the differences not being statistically significant. Acceptable standard means just that - there are no gold, silver or bronze medals in healthcare. It's either acceptable or not. The paper also concludes that deficits are present in both nurse and medical practitioner requiring attention and that ANNPs are capable of taking an advanced role.

I find it slightly ironic that the group most opposed to increasing roles of ANPs in primary care settings tend to be General Practitioners, who it could be argued are equally deficient in knowledge when compared to their specialist colleagues.

Locker10a

Stone Deaf 4evr wrote: »

woah woah woah,

so you'd be happy enough to hear over the intercom "DING DONG, ladies and gentlement his is your captain speaking. Today mary is going to be landing the plane in celebration of her celebrating 15 years with the airline cabin crew"

That would never happen but!! But there was a case in america,i believe it was american airlines where a member of the cabin crew took the captains seat when he died mid flight! She could fly(had a pilots license) but was not an airline pilot! She assisted the co-pilot land the plane !

Nurses and Doctors train for different things! As with Pilots and cabin crew! Pilots are there to fly the plane, cabin crew are there for various safety and security reasons and evacuations and such that pilots would not be trained in! Same goes with doctors and nurses!

jr22

Jimoslimos wrote: »

Fallacy: Appeal to emotion.

I am a parent. That's the capacity in which I would engage with a neonatal unit. I'm not a pre-term baby or a medical professional. I would be pretty emotional in this situation. I'm not appealing to emotion to score points

Jimoslimos wrote: »

Often? Did you read what you just wrote

I did, read it again.

While the results of the study suggest that ANNPs do not perform as well as medical staff, in the majority of cases, they still performed to an acceptable standard.

And what about the minority of cases where the ANNPs don't perform to an acceptable standard?
No need for gold silver and bronze here. In certain cases the ANNP provision of care was below the acceptable standard, plain and simple. Read on below and you'll find the authors of the study don't even have data on the consequences of the instances of sub standard care found in the study, even if it's only in a minority of cases. (It's on the p.42 section below)

Jimoslimos wrote: »

I note you conveniently omitted to include the bit about the differences not being statistically significant. Acceptable standard means just that - there are no gold, silver or bronze medals in healthcare. It's either acceptable or not.

Firstly, the method section highlights that statistically, the results of this study are close to null and void from the outset, it's merely a preliminary exploratory study, not the finished product by any stretch and not something anyone should base a policy decision on.

From p.60
In the absence of similar studies being available for comparison, it was not possible to perform a power calculation to determine the sample size. Moreover, as effect sizes were not known or easily estimated, it was decided that this study would be conducted as a preliminary exploratory study. Following consultation with a statistician a sample size of 60
sets of records was thought suitable for the aims of this study.

The study is preliminary and exploratory, as stated by the authors.


Here's a section form the discussion of this study, page 42, that talks about the caution required around the interpretation of the statistical significance of the study results.

p.42
The lack of statistical significance between ANNPs and medical staff should not, however, be assumed to indicate a comparable level of performance between the two groups. As noted, the trends in the data suggest that in some areas, ANNPs were not as complete or comprehensive in their management of neonates as their medical colleagues. It is difficult in this type of study to identify what actions were taken and by whom, to counteract any errors and omissions occurred and whether there were any consequences for the neonates.

The trends they refer to may (....or may not) have been significant if the power calculations and sample sizes had been adequate to begin with. They also admit that they don't have the data on the consequences for the neonates when errors and omissions occurred.


Here's a section that highlights more methodological shoddiness. The consultant reviewer wasn't trained for the purposes of the assessment that forms the basis of the whole study

p.39
Likewise, whilst there was no formal training of the reviewer, there was an exchange correspondence with the principal investigator to clarify issues around the aims, purposes and processes of quality appraisal procedure and completion of the assessment documentation. This undoubtedly constitutes a methodological flaw of the study, but one that was not easily overcome in this instance.


Sorry Jimo. That study is brutal and the headline conclusion is still this;

While the results of the study suggest that ANNPs do not perform as well as medical staff, in the majority of cases, they still performed to an acceptable standard.

So, defend it if you want to.

Johro

It seems everybody has experience of working in a hospital these days.

jr22

Johro wrote: »

It seems everybody has experience of working in a hospital these days.

Ryanair is probably oversubscribed.

bnt

To go back to the OP's analogy: an air hostess probably couldn't land a plane if left to do so by herself without assistance. However, if she got on the radio to an air traffic controller to guide the plane and give advice, including on how to use the navigation and automation systems in a modern plane, she definitely could. (Heck, I probably could. Way back in 1991, I was on a Airbus flight in South Africa, on which the captain actually told us it was fully automated, including takeoff and landing.)

In the same way, a lot of medicine consists of following instructions, developed by experts to the letter; and in most cases that's enough. I bet a nurse could perform an appendectomy if he or she had someone giving instructions by phone - in fact, I will be very surprised if this hasn't happened many times already. As for common conditions with non-invasive treatments ... there's an app for that. That and other such apps - or "booK" procedures - are not intended or expected to replace doctors, but they can allow nurses to do the "grunt work" before involving a doctor.

biko

You'd think that mechanics would drive slower because they see what can happen if you crash.
What's that all about then?

stoneill

The Backwards Man wrote: »

Don't like that term.

'I shagged a cabin crew last night' sounds like you had sex with an oversized jeep.

I drove me cabin crew to work today.

Nurses are great, drinkin' and smokin' nurses are better.

wicklowstevo

every time I come here there's an idiot sprouting nonsense , I think its time to stop coming here rather than subject myself to these people ......

jr22

wicklowstevo wrote: »

every time I come here there's an idiot sprouting nonsense , I think its time to stop coming here rather than subject myself to these people ......

I agree 100%. If you are having difficulty making sense of what people are saying here you're probably as well off.

jr22

I don't have any problem with nurses being nurses, or Gardaí being Gardaí for another example.

It's the nurses who reckon they are doctors and the Gardaí who reckon they are solicitors that I have a problem with.

If you want the big jobs, boys and girls, you'll have to get stuck into the big books.

wicklowstevo

a garda with 30 years experience doesn't know as much as a newly qualified solicitor ?

typical self important irish people , so basically everyone's a bluffer except you is it ?

and by the way Ireland if full of degree holders on the dole or saving up for getting out,

jr22

wicklowstevo wrote: »

a garda with 30 years experience doesn't know as much as a newly qualified solicitor ?

typical self important irish people , so basically everyone's a bluffer except you is it ?

If a Garda was claiming a level of capability to give legal advice of the standard provided by a qualified solicitor, I'd say they were a bluffer.

Horses for courses. I wouldn't expect Mick McCarthy in his prime to slot in for Messi or Van Persie, even if he bored the bollix off me for an eternity telling me that he could pull it off.

scudo2

The Backwards Man wrote: »

Nurses are sexy.

How come older nurses are not called matrons anymore.
(nurses sounds sexier)

Its like in the butchers shops, no such thing as mutton anymore. Just very old lambs

3 years old lamb !!

That's like us at 30 ?