Talk:Nurse practitioner/GA1

GA Review

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Reviewer: Amanda4187 (talk · contribs) 00:33, 11 April 2019 (UTC)

This article has been significantly altered to paint nurse practitioners as incompetent, manipulative, and unsafe. The article is supposed to be about nurse practitioners who practice advanced practice nursing. Instead the article about a comparison between advanced practice nurses and how they are incompetent to provide care to patients because they are not as good as physicians. In reality, nurse practitioners are not physician's we do not claim to be, we look at patient's completely differently than a physician. Below you find a long list of statements that need to be removed from the article to make it more accurate.

1) "but does not provide the depth of expertise needed to recognize more complex cases in which multiple symptoms suggest more serious conditions."

2) "The opponents of independent practice have argued that nurse practitioner education is "flimsy," because it can consist of online coursework with few hours of actual patient contact. The number of patient contact hours in nurse practitioner training is less than or equal to 3% of physician training.[1] Increased utilization of nurse practitioners is leading to increased cost of care through increased use of resources and unnecessary referrals." - Although not completely incorrect, this is debatable. These comments intentionally paint NPs as incompetent and compare NPs to physicians... that is not the point of the article. This is not a comparison article.

3)"Given the quality and quantity of training, experts have questioned the quality of care delivered by nurse practitioners." This is inaccurate and mainly physician groups such as Physician's for Patients feel this to be true. "The studies we reviewed did not demonstrate a difference between APRN care and physician care in primary and urgent care settings with regard to health status, quality of life, mortality, or hospitalizations."

4) "Studies have shown multiple concerns associated with lack of training. Nurse practitioners are more likely to prescribe antibiotics when they are not indicated.[13]" Although yes, there is a known need to increase Antibiotic Stewardship, please view attached table to see the differences in this associated study. Also, the same study states, "The historical studies and recent literature provide little reason to suspect that there is a difference between APRN care and physician care in primary and urgent care settings with regard to health status, quality of life, mortality, or hospitalizations."

5) "It has also been shown that “there is a tremendous need to enhance nurses’ skills."[14] - The study linked to this comment is was "A cross‐sectional descriptive study was conducted that gathered data from an anonymous online survey of practicing nurses throughout the U.S. Measures tapped EBP knowledge, beliefs, culture, mentorship, implementation, and reported competency for each of the 13 EBP competencies for practicing nurses and an additional 11 competencies for advanced practice nurses." - It was an online survey.

6) "Nurse practitioners are also more likely to make unnecessary referrals.[8]" This statistic is related to Nurse Practitioners and Physician Assistants combined. This statistic is misleading.

7) "They are also more likely to order unnecessary tests and procedures such as skin biopsies and imaging studies."[9][15] This statistic is related to Advanced practice clinicians (i.e. Nurse Practitioners and Physician Assistants) This statistic is misleading.

8) Although a few studies have shown that NPs provide similar quality care when compared physicians, these studies were found to have a medium to high potential for bias and had low to insufficient strength of evidence.[16] The study that is referenced does not support the statement. The article does say, "Strong conclusions or policy changes relating to extension of autonomous APRN practice cannot be based solely on the evidence reviewed here. Although no differences in 4 outcome measures (health status, quality of life, mortality, hospitalizations) were detected, the evidence cannot rule out such differences."

I have no knowledge of NPs from other countries.

9) "Overall, to become an NP requires 1.5 to 3 years of post-baccalaureate training, compared to physicians who are required to complete a minimum of 7 years of post-baccalaureate training." A Nurse Practitioner is not a physician, why is this comparison even in this article? This is an inappropriate comparison.

10) A new nurse practitioner has between 500 and 1,500 hours of clinical training <--(This is accurate) "compared with a family physician who would have more 15,000 hours of clinical training by the time certification.[1]" This is another inappropriate comparison, it is an article about Nurse Practitioners. Also, if it is going to compare NPs to physicians, this is unfair to non-American based physicians. If NPs are being compared to MD/DOs shouldn't other countries be represented here?

11) "The quality of education and applicants for NP schools has been cited as a reason to not allow NPs to practice medicine." This is an opinion, no fact. Nurse Practitioners do not practice medicine, we practice Advanced Practice Nursing.

12) "Many schools have 100% acceptance rates, coursework can be 100% online, and clinical experience is limited to shadowing with no hands-on experience.[23][24]" Although this is not completely inaccurate, this is misleading. Clinical experiences are not "no-hands-on" experiences. They do lack significant oversight from the universities but they are hands-on experiences. The purpose for clinical experiences is to have a hands on experience.

These are my recommendations for review, eleminiation. Amanda4187 (talk) 00:33, 11 April 2019 (UTC) — Amanda4187 (talk • contribs) has made few or no other edits outside this topic.

Amanda4187 your comments on review appear to be off topic and suggests a conflict of interest. Please note that Wikipedia is not a battleground. If you disagree with any of the above please try to establish a consensus instead of trying to sabotage a GA Nomination. Normally, I make it a point to make sure I do not bite the newcomers; However given the number of edits saying the same thing from first time users, I am starting to suspect sockpuppetry or meatpuppetry. Please read through the links and the links that I will post on your talk page and we can see how we can make this page even better. So said The Great Wiki Lord. (talk) 13:59, 11 April 2019 (UTC)

Please keep in mind: even Wikipedia's own description of a mid-level provider (https://en.wikipedia.org/wiki/Mid-level_practitioner) includes several references supporting the statement: "The terms "Mid-level provider" or "Mid-level practitioners" have been widely accepted for many years however, they are now seen as derogatory and offensive." Yet this is how the Wikipedia nurse practitioner article starts out. I'll reiterate: nurse practitioners have been providing health care for over half a century. NPs are currently providing care in all 50 U.S. states, the District of Columbia, U.S. territories and in countries around the world. NPs diagnose, treat, prescribe medications and manage patient care. In the U.S., 22 states, the District of Columbia and two territories grant legal permission for NPs to provide care without physician oversight. The remaining states are exploring whether to grant full practice authority. The National Academy of Medicine (formerly the Institute of Medicine), the National Governor's Association, the Federal Trade Commission, the National Conference of State Legislatures, both the Trump and Obama administrations and others have called on states to remove outdated laws and regulations that hinder patient access to NP care as a way to address health care access and reduce health care costs. Raraavis31 (talk) 14:39, 25 May 2019 (UTC)

Yes, I saw that statement in the Mid-level practitioner article, and I doubt that it's appropriately presented. That term is seen by some people, including the marketing departments of some nursing organizations, as derogatory and offensive. It is not necessarily a generally held view. That article should acknowledge both that viewpoint and also the opposite viewpoint, i.e., that none of the MLPs, including NPs, in any country, have ever been legally permitted to perform the most advanced medical treatments, such as pediatric cardiothoracic surgery, and that there's no shame in admitting that NPs have a middle-sized scope of practice. WhatamIdoing (talk) 15:11, 25 May 2019 (UTC)

WhatamIdoing (talk), do otolaryngologists perform pediatric cardiothoracic surgery? Certainly not, because that is not their specialty and it is not within their scope of practice. The nurse practitioner article should describe the care NPs do provide, rather than comparing NPs to some other type of provider and the care they provide to that of other clinicians. Other clinical roles and professions are described on Wikipedia without comparative language, including terms like mid-level practitioner, and the NP article should follow that same pattern. Miraclecln (talk) 15:46, 28 May 2019 (UTC)

Thank you for agreeing that NPs are not licensed to perform such delicate surgeries.

The legal scope of practice for physicians in the US is literally anything and everything medical. In my home state, the law says "The physician's and surgeon's certificate authorizes the holder to use drugs or devices in or upon human beings and to sever or penetrate the tissues of human beings and to use any and all other methods in the treatment of diseases, injuries, deformities, and other physical and mental conditions." That is not true for NPs. An NP isn't permitted to "use any and all other methods in the treatment" of medical conditions. As an example, an NP who wants to add acupuncture to her practice would have to get a separate acupuncture license, but physicians would not. WhatamIdoing (talk) 15:53, 3 June 2019 (UTC)

Not a Good Article

I agree with the points that Amanda4187 laid out. It appears that TheGreatWikiLord has a conflict of interest and should understand that Wikipedia is not a battleground for physicians or nurse practitioners. Instead of denying repeated requests for change, TheGreatWikiLord must try and establish a consensus and include information that describes nurse practitioners in a factual and neutral point of view.

Regarding point #2 above, not only is the information comparative and intentionally designed to disparage nurse practitioners, it is inaccurate for a large percentage of nurse practitioners who are not educated in online programs.

Regarding point #5 above, that study is on registered nurses in the United States, not nurse practitioners.

Additionally, regarding this sentence "Increased utilization of nurse practitioners is leading to increased cost of care through increased use of resources and unnecessary referrals.[8][9][10]," none of the studies referenced indicate that NPs increase the cost of care, rather they suggest that it is possible for costs to increase in the future, specifically related to diagnostic imaging.

This sentence has no place in the article, and it certainly should not be mentioned twice (in both the opening paragraph and the controversy section). "The opponents of independent practice have argued that nurse practitioner education is "flimsy," because it can consist of online coursework with few hours of actual patient contact.[7]"

There are errors in the page like this: "An average family physician has over 15,000 hours of clin[1] to become ..."

The controversy section includes comparisons to physicians that are out of place in a Wikipedia article. The physician assistant page does not contain comparisons to any other health care provider type, as it should be.

If they are going to mention that nurse practitioners are lobbying for independent practice, which is not the optimal term, they should also mention that NPs have full practice authority in 22 states.

Under quality of care, it says, "experts have questioned the quality of care delivered by nurse practitioners," but no sources are cited and no experts are named. This sentence and the entire section should be stricken.

My time is limited to post today, but this is just a very brief introduction to why the nurse practitioner page should not be granted good article status and should be revised to describe the NP role in a neutral and factual way. Miraclecln (talk) 17:46, 20 May 2019 (UTC)

Comparisons are a tool that encyclopedia articles use to help people understand some subjects. Thank you for identifying the deficiencies in the Physician assistant article. People who want to understand this subject should know how NPs compare to nurses and physicians (different scope of practice), and also how they compare to PAs and COs (similar scope of practice). WhatamIdoing (talk) 18:30, 22 May 2019 (UTC)

Thanks for the discussion on comparisons, WhatamIdoing (talk), however I do disagree. In addition to the Physician assistant article, we might also consider treatment of the field of dentistry or any other profession on Wikipedia. Comparisons are not used by Wikipedia to help readers understand differences in roles within dentistry or other fields. Rather, each role is described separately. That practice should be continued for nurse practitioners, as well. Miraclecln (talk) 16:45, 23 May 2019 (UTC)

Not quite. Physician assistants should be compared to occupations such as physicians, NPs, and MAs. It's the Dental assistants and Dental hygienists that ought to be compared to dentists. Here's a source with typical comparison lists for NPs and PAs. You haven't presented any reason why we shouldn't do something similar in all articles about all professions (including those outside healthcare), beyond the ones we call WP:IDONTLIKEIT and WP:OTHERSTUFFEXISTS. And, yes, Wikipedia actually does this. You can see one example of comparing and contrasting related professions at Artist#Training and employment, in which we compare and contrast different types of artists in terms of education, income, etc. In the healthcare field, we even have a whole article called Comparison of MD and DO in the United States. WhatamIdoing (talk) 17:13, 23 May 2019 (UTC)

Quick Fail

This article meets the "immediate fail" of a good article criteria due to meeting criteria 4:

It is not stable due to edit warning on the page

This article on Nurse Practitioners has been classified as "semi-protected" for months. NPTruth (talk) 16:05, 23 May 2019 (UTC)

Closing due to issues raised above. Best Wishes, Lee Vilenski ^{(talk • contribs)} 14:41, 3 June 2019 (UTC)