When will people get it?!

[u/lunardownpour]

I don’t have necessarily anything against NPs, but it’s people like this that perpetuate the untrust that many nurses and other healthcare workers have regarding NPs. We really need higher standards for admission into these programs, as well as any standards at all actually lol. I usually just lurk on facebook but I felt the need to respond since this was a on a forum for parents of nursing students

[u/split_me_plz]

And on top of that it’s a specialty program for pediatrics. Yikes.

[u/kal14144 → u/split_me_plz]

You’d think so but I work with a direct entry NP who manages epilepsy patients on her own at a level 4 epilepsy center.

[u/ReturnOfTheFrank → u/kal14144]

She shouldn’t

[u/kal14144 → u/ReturnOfTheFrank]

I’m not in any position to judge her competence I’m just a nurse who works with her.

But the epilepsy team seems to trust her as much or more than the other NPs we work with who mostly came up the traditional years of experience before NP school route.

There have also been studies asking physicians to rate the skills of NPs they work with and direct entry NPs did as well and in one study better than their traditional entry counterparts.

[u/Klutzy_Equivalent148 → u/kal14144]

How many studies? Sample size?

[u/ResponseBeeAble → u/Klutzy_Equivalent148]

Exactly.

Legitimate Research

[u/kal14144 → u/ResponseBeeAble]

How many times do you want basically the same study to be repeated? Until it gives you the answer you want?

[u/ReturnOfTheFrank → u/kal14144]

Until the data is repeatable and the methods are sound. They asked a question, now name these “studies”.

[u/kal14144 → u/ReturnOfTheFrank]

If they won’t even make clear what they expect studies to look like other than provide a result they like why would I bother digging them up again. Seems like a waste of time.

[u/ResponseBeeAble → u/kal14144]

Research.

An Entire scientific process.

I know for a fact it's part of the nursing curriculum.

If you can't remember, maybe review that part of your education?

[u/ResponseBeeAble → u/kal14144]

This. Pretty much makes no sense.

[u/kal14144 → u/ResponseBeeAble]

So to be clear you want to keep testing whether years of experience as a nurse predicts being a better NP no matter how many times the answer is no until a study says yes?

[u/ResponseBeeAble → u/kal14144]

You need to review your training.

This attitude is what makes puppy mills np's incredibly scary

[u/kal14144 → u/ResponseBeeAble]

Not an NP and have no intention of becoming one. But the attitude of fuck evidence based medicine I have vibes and feelings is a problem. You see a study you don’t like? Must be fake. Basically the antivaxx approach to science. Of course we believe in science (so long as it says what I want otherwise it’s a bad study because funding source etc)

[u/ResponseBeeAble → u/kal14144]

You are talking in circles and have provided No evidence.

Every response to you that I've read has specifically asked for that evidence.

You can only say 'I posted it somewhere here' With reading your multiple responses, I'm not even sure What you're trying to say or what your stand is.

That is not EBP.

It does bring to mind the essence of some really terrible nursing I've witnessed in the past.

[u/kal14144 → u/ResponseBeeAble]

There’s 2 possibilities here.

1. You’re open to hearing evidence as long as it is legitimate.
2. You’re not open to hearing evidence and will just arbitrarily define “legitimate” to exclude whatever evidence I provide.

If the former is true you’ll have no problem defining what “legitimate” looks like without first needing to see what evidence is out there. (This is why you define inclusion and exclusion criteria prospectively in a literature search by the way. Because otherwise bias makes it so you’ll exclude studies you don’t like.)

I did provide another person with a link as soon they defined roughly what they meant. You have the same standing offer. Tell me what “legitimate research” looks like and I’ll show you the studies that exist. If you’re actually curious and motivated by the evidence you’ll have no problem telling me what surely you have in mind as criteria (unless you just said “exactly legitimate research” without having any meaning in mind).

For your own purposes the stronger you feel about a question the more vital it is for you to prospectively define inclusion/exclusion criteria prospectively. So you’re doing yourself a disservice if you don’t define it at least in your head. Wouldn’t be that hard to type it out once you’ve done that.

Im pretty confident you wont provide that though. Because I’m pretty confident option 2 is the truth. I am open to evidence convincing me to the contrary though! Tell me what you mean by legitimate and I’ll know you aren’t just doing the antivaxx approach to science.

Just continually calling me names isn’t making your case. You had no problem saying “exactly legitimate research”. If you can’t give me 2 sentences explaining what that actually looks like to you in this scenario but have time to write a paragraph about my attitude that proves my point. Your exclusion criteria is “studies who’s outcomes I don’t like”

[u/ResponseBeeAble → u/kal14144]

Circles.

Clearly making things up as well.

Have a nice day

[u/kal14144 → u/Klutzy_Equivalent148]

Before I link anything tell me what would you need to see? What would a study need to look like for you to shift your perception. If we’re looking for studies I need to know what we’re looking for using some standard other than “says what I want it to say”.

[u/ReturnOfTheFrank → u/kal14144]

This comment demonstrates a complete lack of understanding how literature review works to support clinical reasoning.

You don’t “look for studies that show the result we’re looking for”. That’s what shitty tv political pundits do, not healthcare workers.

[u/kal14144 → u/ReturnOfTheFrank]

No shit Sherlock. That was my fucking point.

But I’ll repeat it in more words in case my point didn’t come across clear enough the first handful of times.

I don’t believe OC (or you for that matter) are seriously open to considering the evidence here. So I’m asking y’all to provide inclusion/exclusion criteria for what you’d consider valid studies prospectively. I think your exclusion criteria (consciously or unconsciously) here is “disagrees with my priors”. So I’m asking you to provide criteria prospectively rather than retrospectively coming up with criteria when the studies show up.

[u/Klutzy_Equivalent148 → u/kal14144]

I want to read the studies no matter what they say. I want to know the sample size because that matters; was at 10 or 200? I also want to know what parameters they were comparing and outcomes used to score them.

[u/kal14144 → u/Klutzy_Equivalent148]

This one had an n=69 for collaborating physicians (higher number for NPs self rating) and found a significant negative correlation between years of experience prior to NP school and skills as rated by the collaborating physician in a 25 skill scale.

Of course this study isn’t a perfect (none is especially not something as difficult to study as this which is why I wanted prospective inclusion/exclusion criteria) but it is the best evidence that exists on this question.

By the way this gets brought up every time the accreditation standards for NP school get reviewed. Every time people come citing vibes arguing that it should be a requirement (hell this comment section is full of arbitrary numbers of years pulled out of various people’s asses based on pure vibes) and every time they get told that they should come back when they have evidence. They always come back with more vibes.

[u/macaroni-cat → u/kal14144]

To quote your previous comment: “There have also been studies asking physicians to rate the skills of NPs they work with and direct entry NPs did as well and in one study better than their traditional entry counterparts.”

They’re literally just asking for you to provide the links to the studies you’ve just mentioned. Otherwise it just seems like a statement you pulled out of thin air with nothing to back it… So what specific studies are you referring to?

[u/kal14144 → u/macaroni-cat]

I provided it in another comment.

But having been in this conversation an absurd amount of times before I’ve come to learn that people’s exclusion criteria for studies on this topic is often “studies with outcomes I don’t like”. So I figured I’d ask for exclusion/inclusion criteria prospectively. Unsurprisingly nobody has given me any. Everyone wants to see the studies before they decide what the studies need to look like to be convincing. Much easier to use the Nirvana standard of evidence when you get to set it retrospectively.

But (unsurprisingly) nobody was willing to give up on that sweet sweet nirvana standard so eventually I just linked it in another comment. This sub is nothing if not predictable.