Unfair and unbalanced

Fox News update: Analyzing the story on APRNs and the proposed VA rule

fox_news_11_thumbFriday, June 10, 2016 — Today we finally reached Doug Rohrbeck, executive producer of the June 1 Fox News segment about the proposed Veterans Administration (VA) rule that would allow advanced practice nurses (APRNs) to practice without physician “supervision.” We spoke for about 20 minutes. Unfortunately, we did not see much improvement in his understanding of APRNs, nursing in general, or the lack of balance in the network’s June 1 piece–which relied heavily on the unsupported views of physicians that APRNs are unqualified to practice independently and included no meaningful response from nursing advocates. Mr. Rohrbeck insisted that his segment was “balanced” because it included a variety of people, as if “balance” could be achieved by having different people express the same views on an issue. But an item is not fair to nursing simply because different physicians, journalists, and politicians all express the same uninformed contempt for the profession. So we thought that we would try to explain and illustrate exactly why this piece was unbalanced. More below, but first, please click here to sign our petition and please ask Doug Rohrbeck to apologize and make amends to nurses. Thank you!

What is balance?

fox_news_22_thumbBalance is not always an easy thing to achieve in journalism, of course. We can say, though, that balance does not mean having a plumber, a dentist, an electrician, and an accountant all espouse the same belief that the world is flat or that humans are not causing climate change. In fact, it would not really be balanced even to have a 50-50 split of views on issues like those, because there is such a clear scientific consensus on them–coverage of those issues should reflect the consensus view. But even for issues that are subject to reasonable dispute, like how to address gun violence or whether APRNs are qualified to practice without physicians, balance means having a balance of perspectives. It is also helpful to talk to experts in different camps, and organizations that promote the ideas on different sides of the issues. This model was not followed in the June 1 Fox News segment about the VA rule. We suspect that this problem may reflect a failure to understand that nurses are in fact an autonomous group of educated health professionals who must be consulted in any piece that is about them, not just inanimate health equipment that physicians deploy and about whom only physicians need be consulted.
 
Let’s look at the specifics of the Fox News piece to be sure we understand exactly how the imbalance worked here. The images with the balance scales break the segment down element by element to help Mr. Rohrbeck see why we have concerns about his piece and why we are continuing to pursue our petition to ask the network to apologize and make amends to the nursing profession. In particular, our table includes more details about the piece, how long each sentence took, who said it and how anti-nurse it was. Based on our analysis, there were no truly pro-nurse elements. The report and host were both consistently anti-nurse. All the talking heads who appeared were anti-nurse except for one nursing professor. But she was not introduced as an expert or with credentials, and the part of her interview that Fox chose to include did not make points that would persuasively counter the physician views that received so much air time. There was no mention that APRNs have graduate degrees or that research shows the care APRNs provide is at least as good as that provided by physicians. All we heard were a few general comments that nurses are trained and experienced. And there were no nursing advocates comparable to the physicians and physician group representatives the report consulted who were clearly experienced in making the anti-APRN arguments they did in the piece.

Please click here to sign our petition and please ask Doug Rohrbeck to apologize and make amends to nurses. Thank you very much!

 Timeline (seconds)Length (seconds)Strongly Anti-nurseMild anti-nurseNeutralAnalysis
Bret Baier0:00-0:1516Veterans waiting to see a doctor at the VA may have to settle for a nurse instead. Dept. of Veterans Affairs is proposing a rules change aimed at easing the backlog at VA facilities. Correspondent Doug McKelway tells us how that is going over.  "Settle for a nurse" clearly indicates that APRNs are less desirable practitioners and less qualified than physicians, despite a large body of research showing otherwise.
Doug McKelway0:16-0:227 The Veterans Administration is proposing a federal rule change that would allow highly trained nurses to act as doctors. "Trained nurses" -- is that like trained monkeys? There is no indication in the report that APRNs have graduate degrees or even that they go to college. Because the public has little understanding of nursing education, vague references to "training” could mean a few extra night classes on top of a 6-week post-high school class the student took to become a nurse in the first place. So the public might imagine that nurses' post-high school education lasts a few months, instead of the 6-10 years of university training APRNs actually receive.
 Timeline (seconds)Length (seconds)Strongly Anti-nurseMild anti-nurseNeutralAnalysis
Doug McKelway0:23-0:275 Doing diagnostic testing, prescribing medications and administering anesthesia. This suggests that nurses are not qualified to do these things, even though they are doing them right now and doing them as well as physicians.
Doug McKelway0:28-0:347 Over 6,000 of the VA’s 93,000 nurses would see roles expanded, a trend that is also happening in the private sector. This suggests that the 6,000 APRNs are no different from other RNs. The change the VA is proposing is that APNRs would no longer need physician “supervision,” which research shows is unnecessary. In addition, since physicians are not nurses, they could not adequately supervise APRNs. APRNs have a broad scope of nursing knowledge that physicians do not have or provide. Nurses do not seek to become physicians. By diagnosing health conditions, prescribing medications and tests, and providing anesthesia, nurses are not acting like physicians. They are acting like APRNs--providing a more comprehensive model of care. APRNs consider the whole patient: mind, body, soul, family, educational level, nutrition, water supply, environment, housing, transportation, social class, social structure and much more—the full range of things that affect patients and their health.
 Timeline (seconds)Length (seconds)Strongly Anti-nurseMild anti-nurseNeutralAnalysis
Susan Ruppert0:35-0:4511  We do come, first of all, with a nursing background, many nurse practitioners have many years in health care before they even become nurse practitioners and we bring that to the table.This suggests that nurses have been around a long time, but wallpaper has also been around a long time, so this is not enough to show that nurses are competent or qualified. We are confident that Dr. Ruppert said more in her interview, so the inadequacy is not her doing but the result of an editorial decision by Fox. Susan Ruppert was never identified with her RN or PhD credentials, nor was she identified as a professor, which she is. Yet the physicians in the piece were identified as physicians.
Susan Ruppert0:46-0:505  But we do have clinical education and training in our programThere is no indication how much “clinical education” APRNs receive, and there is no mention of formal university education. "Clinical education" sounds like “on-the-job-training” and as mentioned earlier, there is never any indication that nurses have graduate degrees. 
 Timeline (seconds)Length (seconds)Strongly Anti-nurseMild anti-nurseNeutralAnalysis
Doug McKelway0:51-0:599Several physicians ‘groups are opposed to the rule change, warning of potential bad outcomes if nurses are left to treat patients with sudden unexpected complications.  Only physician groups are worth consulting? Does Fox News know that nurses have organizations that could speak on this issue? Consulting only physician groups suggests to the public that nurses are not autonomous but are at most junior physicians, as well as that physicians educate, supervise, and control nurses. It runs counter to nursing autonomy, a fundamental concept in nursing ever since Florence Nightingale worked hard to stake out the profession's autonomy in a standoff with physicians in Scutari.
Dr. Samuel Spagnolo1:00-1:1415I know well what happens in acute care hospitals on a daily basis. I’ve been there for almost 50 years. Patients may look to be doing very well, and only a few seconds later, they’re at death’s doorstep.  This is ridiculous. If anyone is at the patient's bedside--watching them minute-to-minute, detecting subtle symptoms, making changes to turn around a deteriorating patient--it is nurses, not physicians. 
 Timeline (seconds)Length (seconds)Strongly Anti-nurseMild anti-nurseNeutralAnalysis
Doug McKelway1:15-1:239Florida Republican Congressman David Jolly is outraged by the proposed change, noting that in March he specifically asked VA Secretary Robert McDonald about it.   
Florida Republican Congressman David Jolly1:24-1:318 I know the proposed rule recently went to OMB. Can you maybe describe your position on this issue? Though the specific language in this sentence is not pro-physician, it continues the sentiment from the preceding sentence that the Congressman is “outraged,” which will seem like a reasonable  sentiment, lending support to the physician position.
Robert McDonald Veterans Affairs Secretary1:32-1:365The thing we feel least comfortable about is anesthesiologists  Here is a clip extracted from remarks by the VA Secretary, but who knows how long he spoke, what else he said, or what the context was. Why is he putting forth the change in rules if he feels so uncomfortable? 
 Timeline (seconds)Length (seconds)Strongly Anti-nurseMild anti-nurseNeutralAnalysis
Florida Republican Congressman David Jolly1:37-1:4812I would go so far as to say we have been misled as a Congress and a country by the VA Secretary and by the Dept of Veterans Affairs who said they were not going to issue this rule. But in fact did.  "Misled"--as if it is a scandal that APRNs are being allowed to practice without physician oversight.
Doug McKelway1:49-1:524 Anesthesiologists also maintain the proposed change is unnecessary.  
Daniel Cole MD1:53-1:575 There is no shortage of physician anesthesiologists in the VA.  
 Timeline (seconds)Length (seconds)Strongly Anti-nurseMild anti-nurseNeutralAnalysis
Doug McKelway1:58-2:1613 In fact whatever other problems, it is practically swimming in anesthesiologists. The American Society of Anesthesiologists today said that there are only seven job openings for anesthesiologists at the VA out of a total number of 1,188. Well below the private hospital average where there is a greater need. Bret? Although the report suggests that the VA has many anesthesiologists, that does not mean they are better suited to provide care than CRNAs are, and the research shows otherwise. The report also fails to note that anesthesiologists as a group are apparently less eager to practice in battlefield settings, where CRNAs provide much of the anesthesia, as the president of the American Association of Nurse Anesthetists pointed out in his reaction to the physician groups' position
Bret Baier2:16-2:171  Doug, thank you. 
 Timeline (seconds)Length (seconds)Strongly Anti-nurseMild anti-nurseNeutralAnalysis
Total number of seconds 132    
On screen text0:19 - 1:2061“NOT WHAT THE DOCTOR ORDERED: NURSES WOULD TREAT VETERANS UNDER V.A.PLAN  There is no balance in the on-screen banner; it is all pro-physician.
On screen text1:20 - 2:1050“NOT WHAT THE DOCTOR ORDERED: ANESTHESIOLOGIST SAY PLAN LOWERS CARE STANDARD   

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