Dr. Danielsen’s descriptions of each generation (Generations: moving through time. Clinician Reviews. 2011;21: cover, 24-26) were right on track. Technically, I am considered a Baby Boomer but feel more like a GenXer—most likely because I was born late in 1961, only a few years before the first GenXers. Whenever I read about the qualities and feelings of the Baby Boomers, I don’t really relate. Maybe I am on the Boomer-GenXer cusp?
I was not even two years old when JFK was shot and was in kindergarten during the Summer of Love. In good GenX form, I have embraced new technology, especially the electronic medical record and e-mail as a means of patient contact—although some older Boomers absolutely hate this. Office processes are slowed and the risk of errors is increased by those who leave sticky notes rather than use the computer to communicate important messages. Not so good for the patient.
In my experience, though, the young adults in Generation Y are the most difficult to work with; they expect recognition for everything they do. When they show up for work on time, they feel they deserve “employee of the year.” What older workers consider part of the job, GenYers think is beneath them.
When I was a kid, you did what you did because you were told to; if not, there would be a negative consequence. Young adults today were raised with positive reinforcement for minimum effort and few negative consequences. Their childhoods were full of scheduled soccer games, little time spent outside, and ribbons and trophies for barely performing—all in an effort to increase their self-esteem. Unfortunately, it backfired. We’ve found out that a little more “do it because I said so” goes a long way in raising a child with a good work ethic.
Hopefully, part of the difference I see between the Boomers and GenYers is just youth. We all get smarter as we age, and those ahead of us probably had similar feelings about our generation. Only time will tell.
Alice Haines, FNP, MSN, Rocklin, CA
One strong characteristic of the Boomers (I am a borderline “Boomer,” born in 1944) is that we identify with our careers and the work ethic. I am having a lot of ambivalence about retiring, even at age 67. The structure that we had growing up was determined in our own imaginations of childhood and summertime. So when we hit the work force we became our careers, not realizing that we needed to balance our drive for work with recreational interests and hobbies.
We now watch our grandchildren twitter, text, and play with gadgets. They are overscheduled, full of self-esteem, and emotionally uninvested in tradition or family roots. The challenge to bridge all generational prototypes, whether in the workplace, church, or home, is to figure out how to slow down the communication explosion and regain that human connection that is felt from gathering around a family dinner table, hearing a voice on the other end of the line, or receiving a personal card or letter in the mailbox.
I am especially grateful to have seen the past six decades and to experience the changes that each one has brought. I still like holding a hard copy of the newspaper as opposed to perusing the computer screen, or a book instead of an e-reader. I also want to be involved, needed, and challenged to make a difference in the lives of others. Hopefully, that is the common thread between all generations and the generations to come.
Penelope Daniels, BSN, MS, FNP-C, Huntington, WV
Is Enough Vitamin D “Enough”?
In graduate school, I did a literature review on what the new guidelines for vitamin D supplementation should be, so I was pleased to read the article (Vitamin D: how much is enough? Clinician Reviews. 2011;21: cover, 23, 35) stating that the Institute of Medicine has increased the RDAs for vitamin D and calcium. However, my concern is that 600 IU/d is not a sufficient daily dose of vitamin D.
When considering vitamin D, one must look at the current American culture. According to the CDC, approximately one-third of all Americans are obese, and this proportion is increasing; thus, at least one-third of adults in this country are not getting proper nutrition. Besides sunlight, sources of vitamin D are typically milk and other dairy products, orange juice, fish, and cod liver oil. Are the obese people in our country eating these food items? Probably not.
Also, according to the CDC, the incidence of melanoma has increased by around 3% for men (from 1986 to 2006) and women (1993 to 2006). As a result, there has been increased awareness of the importance of sunscreen use; unfortunately, sunscreen prevents the absorption of vitamin D.
Furthermore, it is known that people who live north of the 37th parallel do not get the sunlight they need, except during the summer months, to maintain adequate levels of vitamin D. Taking into account these three arguments, it would seem to me that the new guidelines’ RDAs are probably insufficient for most people.
As practitioners, we all must remember that treatment should be individually based, so keep in mind your patient population prior to recommending doses.
Kaylinn Miller, APNP, Wauwatosa, WI
Collaborating Never Goes Out of Style!
I’ve been a PA for the past 17 years, and I’ve worked with a variety of professionals through the years—mostly in supportive working environments. Like Dr. Danielsen (Educate to collaborate. Clinician Reviews. 2010;20: cover, 4), I’ve had the opportunity to work with physicians and NPs who value my professional skills, and occasionally, I’ve helped to enlighten a few others.
I’ve also been a student preceptor for a number of PA students, medical students, and two NP students. I find it interesting that the NP students (from different programs) both advised me that they would need my supervising physician to handle their oversight, but that they wanted to spend their clinical time with me, since they ultimately felt more aligned with me as a “midlevel.” Neither of their programs would allow them to do a clinical with a PA.
I have a unique perspective from another direction as well. My sister completed her NP program last year. While in the didactic portion of her program, she frequently recounted conversations from program faculty members discussing the differences (ie, inferiority) of PAs, compared to NPs. Perhaps my memory has faded from 17+ years ago, but I don’t recall my program leadership discussing the NP profession other than to say that our end point is similar, but our path is different.
I’m sure my sister’s instructors became tired of her opinions countering theirs, but I’m proud she was willing to voice her thoughts as the lone duck in the crowd. As a side note, her program wouldn’t allow a clinical with a physician assistant, either. Perhaps PA programs generally give the same instructions and I just didn’t notice at my alma mater so many years ago.
At the end of the day, I’ve rarely been one to engage in the banter over the NP/PA debate—it just feels so unproductive and disrespectful to both professions. And I’ve lost little sleep over the occasional dismissive physician, since my schedule stays full of patients wanting to see me.
That said, I do appreciate the comment that dismissing differences can endanger professional relationships. How true a statement that is! There are differences, but they don’t have to lead to adversarial relationships. More importantly, continuing to draw such lines will be more divisive than ever. Our patients can’t afford that anymore. Our health care system can’t afford that anymore; it will fiscally fracture in my career-time without conservation of resources and collaboration of education, services, and dollars.
Medicine and how we deliver care is changing at no greater speed than right now. If we don’t prepare ourselves for that change, our patients lose and so do we.
Nichole Bateman, PA-C, MPAS, Miami, OK