Assignment Two

Samantha Sealey

Introduction
As we go through our everyday lives, we never really realize the importance of
our healthcare or the problems that go on with it. Our healthcare field is surrounded by

Comment [1]: The Intro/Background info is typically

longer than one paragraph because of what we needed
to cover based on the Ass. 2 outline. You broadly
introduced the topic but you did not explain your
reasoning for carrying out the research and study. Also
add why you may be biased in performing your study
(entering conversation.

numerous of doctors, nurse practitioners, and physician assistants that are in various
specialties; these occupations are also known as our healthcare providers. We also
generally do not understand the complexity of our healthcare providers and how each
differs or relates to one another. A nurse practitioner and physician assistant both work
underneath a doctor which arouses some patients to become skeptical of their work and
intelligence. This is one of the many factors that are discriminated upon to our health care
providers. As you continue to read, you will learn the similarities and differences of our
healthcare providers and how they can cause uncertain patients to discriminate them.
Also, the several other factors that are discriminated on of our healthcare providers will
be discussed as well.

Literature Review
In todays society, we depend on healthcare for various reasons. Whether we are
getting a cold, yearly check ups, prescription refills, emergency needs, etc. We always go
to some type of clinic or hospital to find answers to resolve our issue. In order to receive
these answers, we must rely on a doctor, physician assistant, nurse practitioner or a
nurses decision for our health concerns. Majority of the time when we go to the clinic,
we normally are seen by a nurse first then a doctor or sometimes a physician assistant or
nurse practitioner. The expectation is that the substitution of PAs or NPs will reduce costs

Comment [2]: This section was good overall. Maybe

state why you re more biased to one system. If you are
at all.

Comment [3]: You utilized your sources and did put

them in a cohesive manner but did not necessarily use
a variety of sources. There seemed to be more journals
than anything else. Not that its bad but its always better
to have a variety.
Comment [4]: The beginning of your Literature review
seems more like a background info section. Maybe
instead of restating as much as what your studying and
add more of the information you have found.

Assignment Two
Samantha Sealey
and doctor's workload while maintaining quality of care (Van Vught, Hettinga, Denessen,
Gerhardus, Bouwmans, Van Den Brink, & Postma 2015). A physician assistant and nurse
practitioner are similar but are also different. Both occupations require a masters degree
but while in school, a nurse practitioner is allowed to alter his or her clinical experiences
to their chosen specialty while a physician assistant just requires a clinical rotation
through all specialties without a chosen specialty (Freda 2000). These occupations are
very helpful in our healthcare field. From observing a physician assistant, I learned what
they do during the day. PAs work with doctors and have patients like they do, they refill
prescriptions, diagnose patients, provide care and can receive help from their supervising
doctor if need be (Berry 2016). This is where a physician assistant and nurse practitioner
can begin to differ. A nurse practitioner is an academically advanced and experienced
registered nurse and they are not required to work under a doctor like a physician
assistant is required to do but they are allowed to if they would like (Cresswell 2013).
Thus, nurse practitioner programs are based off of a nursing foundation, which makes
them similar to a registered nurse in certain ways. Both of these professions strive to
ensure better patient outcomes, so do physician assistants and doctors. A registered nurse
is only a two year accredited nursing program (Wrenn, 2016). Registered nurses only
require two years of nursing school because they are not of a higher level like the other
careers mentioned. A nurse practitioner and physician assistant are both under the
supervision of a doctor, which can make them seem skeptical to their patients. Some
consumers without the label of a doctor could mean they are not experienced or dont
have the education of a doctor, especially if the person has no clue what a PA or NP is. A
physician or doctor has the most education out of all of these professions. In order to

Comment [5]: Just a heads up, this sentence seems a

little off. Not one of my comments for a grade, but just
thought I would let you know.

Assignment Two
Samantha Sealey
become a doctor one must earn their doctorate degree, go through several years of
residency, and take their board exams. This is what allows them to be at the top because
they have more education and experience. This is what causes the patient skepticism but
could there be other factors that play a role besides their education and experience? On
average, a nurse practitioner or physician assistant will spend about 12 minutes face to
face with their patient which is more than the averaged 7.5 minutes from the doctor, they
also spend more time diagnosing and prescription refills (Venning, Durie, Roland,
Roberts, & Leese 2000). This is one major character in receiving positive patient
outcomes. The longer one on one time a healthcare provider spends with a patient, he or
she will then gain your trust and intelligence. This will also lead to less confusion with
patient diagnosis and treatment, which indicates positive feedback. Patient treatment is a
very important quality in healthcare. How and what the patient are treated with is very
important among their diagnosis. For instance, a registered nurse could have a patient
with specific symptoms of a sickness. The RN is allowed to make assumptions but, they
are not allowed to diagnose them; this is what a doctor, PA, and NP is for. The RN could
then send their patient to the clinic where he or she would be seen by one of these three
professions. If this scenario had gone different, the patients treatment outcome could
have been greatly affected. This is one reason why all healthcare affiliations provide
greater quality monitoring (Madison 2004). A factor that plays a role in patient
skepticism is discrimination. We as people tend to discriminate people, which, can be
hurtful and is disrespectful. For instance, some patients tend to discriminate against a
healthcare providers race or ethnicity assuming he or she is not as intelligent as their race,
gender, or ethnicity. This tends to be more seen in hospital settings. Many spoken

Assignment Two
Samantha Sealey
languages from different cultures surround our healthcare field; this allows us to have
access to people with multiple linguistic abilities. Even though patients tend to judge a
book by its cover at times, these linguistic aspects of cultural competence have been
associated to decreases in racial/ethnic disparities in health and healthcare (Johnson
2004). These negative stereotypes and discriminations are deeply embedded in the culture
and institutions of our society (Williams & Mohammed 2008). Any cultures will more
than likely continue to discriminate on others for several decades because; societies seem
to have a natural instinct to judge others. All of these characteristics of skepticism
definitely affect patient gratification. The development of positive ethical conditions is
important to the evolution of quality work environments and quality patient outcomes
(Pauly, Varcoe, & Storch 2009). Whether or not a patient would be more satisfied with
being treated from a doctor versus a nurse practitioner or physician assistant, their
providers race, gender, ethnicity, religion, should not be of any concern unless it affects
their medical tendencies in a negative way.
Over the past several decades, our healthcare field has seemingly grown in the
amount of people that are becoming physician assistants and nurse practitioners over a
doctor. Even though they are highly qualified healthcare providers, patients seem to
believe that since they do not have as much experience or education as a doctor, there are
not as intellectual as a doctor. Although a doctor does have more education and
experience, a physician assistant and nurse practitioner are both qualified to diagnose,
prescribe medications, perform minor operations, etc. People also tend to discriminate
against their healthcare providers or nurses age, body appearance, ethnicity, hygiene,
gender, race, religion, spoken language etc. What factors do patients tend to discriminate

Assignment Two
Samantha Sealey
on more than others? Do patients judge their health providers label more or less than
discriminating their qualities? A study should be conducted to determine if consumers
would prefer a doctor over a physician assistant or nurse practitioner, vise versa, or if it
doesnt matter to them. Also to determine if consumers discriminate and what factors do
they discriminate on more than others.
This study will be conducted in three different settings in order to receive
opinionated answers to these questions. These different settings will be various hospitals,
outpatient clinics, and random people outside of the other two settings. In order to gather
answers, interviews must be taken place. There will be 12 different interviewers, four in
the hospital, four in the outpatient clinic, and four in the city outside of the clinic and
hospital. Since we are asking two different questions in this study, two of the four
interviewers in each group will be asking about their opinion on having a physician
assistant or nurse practitioner as their healthcare provider and the other two interviewers
will be asking about what they tend to discriminate on with their healthcare provider or
nurse. While we are trying to find these answers, the interviewers will be dressed very
professionally but they will be of various races, genders, ethnicities, body appearance,
etc. Reasons to split the four interviewers into two groups and have different settings is to
avoid biased answers and to receive different opinionated answers. More specifically:
Each subgroup of two interviewers in the same four-interviewer group must be
man and woman; therefore, there will be a total of six women and six men
interviewing consumers. This is being done to keep track of different facial
expressions to the questions.

Comment [6]: Amazing job with the study but I found

myself getting lost a couple times as I was reading.
That is probably an issue on my end but I feel readers
do tend to lose focus and maybe some of the
information for your study could've been condensed. It
could be a clarity issue as well, I had to re read at times
to fully grasp the concept of what you planned.

Assignment Two
Samantha Sealey
Each group of four interviewers has two subgroups of two interviewers. One
subgroup will be asking the Interview Questions A about their opinion on having a
physician assistant or nurse practitioner as their healthcare provider versus a
doctor and the other subgroup will be asking Interview Questions B about the
discrimination of healthcare providers and nurses.
All of the patients being interviewed must be ages 18 and up because younger
patients may not understand the questions or why theyre being interviewed. Two
interviewers must ask 50 random patient Interview Questions A and the other two
must ask 50 random patients/people Interview Questions B as well but they
cannot be the same person asked for Interview Questions A.
The four interviewers inside the outpatient clinic will be interviewing random
patients that is either waiting in line or leaving the clinic from their appointment.
Two interviewers asking 50 random patients Interview Questions A will be at a
different outpatient clinic than the other two who are asking 50 random patients
Interview Questions B. This is being done so we can have a variety of people and
not asking one person two sets of questions.
The four interviewers inside the hospital will be interviewing random patients that
are just in the general care unit. Two interviewers asking Interview Questions A
will be asking 50 random patients and the other two interviewers asking Interview
Questions will be asking 50 random patients as well but they must be different
from the patients than the ones asked for Interview Questions A.
Lastly, the other four interviewers will be going to other places in the same
county as the clinic and hospital to interview 50 random people Interview

Assignment Two
Samantha Sealey
Questions A and 50 random people Interview Questions B that are not currently
being patients inside a facility.
Interview questions A:
1. In todays society our healthcare providers are not just doctors; there are physician
assistants and nurse practitioners. Knowing that nurse practitioners and physician
assistants tend to work underneath a doctor and have less education and less
experience, would you trust having a nurse practitioner or physician assistant as your
healthcare provider versus a doctor?
2. When going to an outpatient clinic and your temporary provider is a doctor, would be
feel less uncertain since he or she is not a physician assistant or nurse practitioner?
3. Now, if you are a patient staying the in hospital and your healthcare provider is a
doctor but you have a physician assistant to come and do check ups, would you feel
like you are not receiving the same level of care?
4. To continue from question three, would you feel any different if you had a nurse
coming to do your check ups and take your vitals even though they are trained to do
so?
5. If you were skeptical to having a nurse practitioner or physician assistant as your
healthcare provider versus a doctor, explain why that is even though they are trained
to do so. Also, if you were uncertain about having a nurse take your vitals or draw
blood, explain why having a nurse to do these duties makes you feel that way.
Interview Questions B:
1. If your healthcare provider were of a different race or ethnicity of you, would you feel
like you are treated with the same level of care as a provider of the same race or

Assignment Two
Samantha Sealey
ethnicity as you? If they were not fluent in your language, would you be less trustful
of them?
2. If your healthcare provider were of a different gender, would you feel like you are
treated with the same level of care as a provider of the same gender as you?
3. If your healthcare provider were apart different religion, would you feel like you are
treated with the same level of care as a provider of your religion?
4. If your healthcare provider had a difference appearance than you, for example is
covered in tattoos and looks different than any other provider youve had before,
would you feel like you were treated with equal level of care?
5. If you answered yes to any of these questions, could you explain why you would
discriminate that factor with their level of intelligence and providing equal care?

After conducting all of these interviews we now compare the results of each
category. When comparing the results find how many had the same answers for each of
the questions in both categories. Once you find the percentages for all of the answers you
can then compare which discriminating factor happens more or less than others. You can
also determine the percentages of how many people prefer a doctor versus nurse
practitioner or physician assistant, or if they simply do not have a preference. Also, when
calculating the percentages, separating the interviewees by ages category with their
answers. Calculating all of these differences will hopefully develop a reasoning as to why
people discriminate on certain factors, and why people tend to trust the label of a nurse
practitioner or physician assistant less than a doctor. After calculating these percentages
you can these publish these results on a valid medical website.

Comment [7]: I found your whole scheme for the study

you purposed really interesting. I think the way you set
up the groups and questions will really optimize your
informative responses. I am intrigued to see how this
study turns out.

Assignment Two

Samantha Sealey

Conclusion
The healthcare field is constantly expanding in the amount of people pursuing

Comment [8]: For the conclusion you were on the right

track but forgot to discuss a few points. One of the
points missing is how your work refers to other works
mentioned in your lit review. Also could've expanded
more on discussing the results of your research.

their career, new research methods, new medicines, education, and more. With such a
developing field, there are also many diverse races, ethnicities, religions, genders, spoken
languages, body appearances, etc. All of the factors sometimes play a role with each
other in the opinion of patients and people. There are going to be people who are going to
want a doctor as their healthcare provider or a nurse practitioner or a physician assistant
or there are some who simply do not have a preference. Also, there are going to be
patients or people who are going to questions ones ability and qualities in their
professions because they are a difference race, ethnicity, gender, religion, etc.
Throughout this study, it is also important to understand the patients and peoples
answers to the questions and connections to their opinions. People are going feel very
strong about their opinion and some are going to care but not feel strong on their opinion.
When a patient or person states their judgment, the interviewer cannot change their facial
expression or states their opinion. As for the healthcare provider being discriminated
upon should make their statement on how qualified and determined they are before their
patient decides if they want a new provider or not. A further study would need to
conducted in order to answer why people and patients manage to discriminate factors of a
human being or healthcare worker before realizing they are perfectly qualified. Even
though it is not right for anyone to question a healthcare providers or anyones abilities
by discriminating them, there are going to be people who continue to do this and our
society will more than likely continue to do this no matter how hard we try to stop it.

Comment [9]: Why would they not be able to change

their facial expression or state their opinion? Also the
first paragraph gives the feel of a summary. Perhaps
tweak it around a bit to give more of an overall flow?

Assignment Two

Samantha Sealey
References

Berry, A., PA. (2016, February 5). Observing Amy Berry, PA [Personal observation].
Cresswell, S. (2013, December 23). What's The Difference Between a Physician
Assistant and A Nurse Practitioner and What Should You Choose?
Freda, C. E. (2000). Nurse practitioner versus physician assistant. Nephrology Nursing
Journal, 27(2), 26.
Johnson, R. L., PA. (2004, February 27). Racial and Ethnic Differences in Patient
Perceptions of Bias and Cultural Competence in Health Care.
Madison, K. (April 01, 2004). Hospital-Physician Affiliations and Patient Treatments,
Expenditures, and Outcomes. Health Services Research, 39, 2, 257-278.
Pauly, B., Varcoe, C., Storch, J., & Newton, L. (2009, September). Registered Nurses'
Perceptions of Moral Distress and Ethical Climate.
Van Vught, A., Hettinga, A., Denessen, E., Gerhardus, M., Bouwmans, G., Van Den
Brink, G., & Postma, C. (2015). Analysis of the level of general clinical skills of
physician assistant students using an objective structured clinical examination.
Journal of Evaluation in Clinical Practice, 21(5), 971-975. Retrieved September
17, 2015.
Venning, P., Durie, A., Roland, M., Roberts, C., & Leese, B. (2000, April 15).
Randomized controlled trial comparing cost effectiveness of general practitioners
and nurse practitioners in primary care.
Williams, D. R., & Mohammed, S. A. (2008). Journal of Behavioral Medicine.
Discrimination and Racial Disparities in Health: Evidence and Needed Research,
32(1), 20-47.

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Samantha Sealey
Wrenn, W. (2016, February 9). Interviewing a Registered Nurse [E-mail interview].