That was insulting because he provided some very good reading material for us? I don't get it.
nurses-masquerading-as-doctors
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That was insulting because he provided some very good reading material for us? I don't get it.
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No problem. If you want to get involved with a political action committee that best represents your interests you can check out this list here:
PACs Health Professionals
Of course, there is always the AMA PAC.
Happy trails!
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It was rude because he told Ji Lin to "come back when she has something intelligent to say." I suppose in your book that is not considered rude? From what I can tell, she has provided a lot of intelligent information based on considerable experience an an ICU RN who is now a med student.
However, since many of you are dead set on chasing windmills, most of the reasonable information provided by a number of RN's is written off as either idiotic, lies, or "unintelligent." Because it is not what you want to hear.
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You're right JL, at least in my n=1 experience. My wife is graduating NP school with a master's and has repeatedly stated she will not go back to school again.
I just jumped in here and did not read the whole long thread prior to this, but to me it seems like the DNP movement might actually help us as doctors. Using my wife as an example, requiring a DNP to practice as a nurse provider might prevent them from crowding us out since they overwhelmingly do not want to have to earn a doctorate. Compare that to now where master's-level NPs are the standard, with the oldest of the bunch grandfathered in to practice with bachelor's degrees!
As for your comment on power of nurses vs. doctors, I respectfully disagree on a significant part of that--nurses have way more bargaining power than resident physicians. They have contracts with amazing benefits and are near impossible to fire even WITH cause. (Compare that to the multitude of resident posters who are terminated.) At hospitals where my wife has worked as an RN they call residents for middle-of-the-night blood draws since they are "not allowed" to draw from patients unless it's from a PICC or central line. And at her current hospital, a new-grad nurse with a BSN makes a larger annual salary than a senior surgical resident (really senior, like even PGY-7), while working less than half as many hours weekly. At her old hospital the nurses were "not allowed" to clip a patient's toenails so that became the resident's job.
Going back to the meat of this topic, I got all you suckers beat. If we win, well then...we win. If nurses win, my wife makes more money and I have successfully hedged the system.
Kind of like my own credit-default swap or whatever.Don't misquote him. He said "Read every article here and get back to us with an intelligent response."
I appreciate where you are coming from moo, and I hope I am wrong on this, but I am sensing that you will be spinning your wheels.
Far be it from me to waste my energies on any unnecessary hating or controversy. Moo, I simply don't see DNPs taking over. I don't think for a minute that the GP, for one, will go for it. I do think there are much greater issues with which to be concerned. I took one look at some of these DNP programs and immediately could not see this as an alternative for medical school. Honestly, even if I never get in medical school, I would NOT put money into such a program. I mean no disrespect to anyone or anyone that put work in program development for DNP--I just don't see it, except where it might be helpful in terms of working in an academic setting.
I mean just look at the history of medicine in this country in the first place. There is a reason "Dr." came about with regard to being a physician in this country. And so much has evolved since then. I just can't see how DNP will work, even if there is Dr. involved in the credentialing. Maybe I'm wrong, but I don't see zillions of nurses flocking into these programs. I guess we'll see. . .but again, nursing is different than medicine. I just makes sense that if you want to become a physician, go to medical school.
What I am not sure about is why there seems to be some general negativity from some with regard to nursing. And I can't help but sense this is an issue for some folks. I mean maybe they legitimately feel threatened by DNP or NPs or whatever. I just don't see it becoming accepted by the GP.
At any rate, I'm not in a position to do anything remarkably powerful about it right now--either the DNP-threat-issue or any perpetuation of nurse-hate, and my energies have to be used on my goals.
It's just that you happen to look at some forums and topics, and it's like "Wow. Really?"
So, I'm focusing more now on threads that I deem helpful to me in my current and future goals.
And don't let anyone get to you. Conserve energy for your goals I say.
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Here's the logic of nurses: Ask a nurse why BSN's make more than RN's. Then ask them why NP's make more than BSN's. Now ask why a MD makes more than a NP and they'll answer, 'They shouldn't, we can do anything they can and know just as much'. Typical nurse attitude.
I appreciate where you are coming from moo, and I hope I am wrong on this, but I am sensing that you will be spinning your wheels.
Far be it from me to waste my energies on any unnecessary hating or controversy. Moo, I simply don't see DNPs taking over. I don't think for a minute that the GP, for one, will go for it. I do think there are much greater issues with which to be concerned. I took one look at some of these DNP programs and immediately could not see this as an alternative for medical school. Honestly, even if I never get in medical school, I would NOT put money into such a program. I mean no disrespect to anyone or anyone that put work in program development for DNP--I just don't see it, except where it might be helpful in terms of working in an academic setting.
I mean just look at the history of medicine in this country in the first place. There is a reason "Dr." came about with regard to being a physician in this country. And so much has evolved since then. I just can't see how DNP will work, even if there is Dr. involved in the credentialing. Maybe I'm wrong, but I don't see zillions of nurses flocking into these programs. I guess we'll see. . .but again, nursing is different than medicine. I just makes sense that if you want to become a physician, go to medical school.
What I am not sure about is why there seems to be some general negativity from some with regard to nursing. And I can't help but sense this is an issue for some folks. I mean maybe they legitimately feel threatened by DNP or NPs or whatever. I just don't see it becoming accepted by the GP.
At any rate, I'm not in a position to do anything remarkably powerful about it right now--either the DNP-threat-issue or any perpetuation of nurse-hate, and my energies have to be used on my goals.
It's just that you happen to look at some forums and topics, and it's like "Wow. Really?"
So, I'm focusing more now on threads that I deem helpful to me in my current and future goals.
And don't let anyone get to you. Conserve energy for your goals I say.
I agree with you they dont have the education and training to safely replace physicians, but the public and polticians dont know this and the nursing lobbies try to obfuscate the differences in many different ways. Alot of people dont know about residency and how hard it is, there have been many people who ive talked to who said well at least when your done with med school you'll make bank - this is what the general public thinks, they have no idea the rigors of becoming a physician.
Its not an anti nurse attitude.
I dont know what more we can do. We posted multiple articles and documents where nurses and the lobbies themselves say they are better trained than physicians, should get the same practice rights and payments. Nurses have created a doctorate program, which the creator herself has said she wants to replace physicians with her "better" DNPs. They are creating residencies and boards to claim theyve done residency and are board certified.
If all you can say is you simply dont see it happening, without any reasoning or proof to say otherwise or rebut all the articles that have been posted (i dont see any nurses going on tv saying that they cant replace physicians), then no amount of reason or logic will convince you otherwise.
I hear you. But here is my position in a nutshell: Get and continue to keep the GP on your side of things.
As a RN, I have seen over and over, first hand, how the road to becoming a physicians is MUCH harder. I have pretty much lived with and seen the rigors or residencies and things like board certification. Many residents are excellent at sharing, describing, and showing what they go through. Working with and around them closely, so many of us nurses have witnessed them working to keep their arses from dragging, while still looking and being sharp and on the ball and dealing with problem after problem and crisis after crisis. Maybe it's b/c I've worked in critical care and with many internal medicine residents, those that are pursuing intensivist tracks, anesthesiologist, and surgical residents and fellows; but I have never been under any delusions about what is expected of them and what they MUST go through. In fact, earlier on in my nursing career, I wondered if I could subject myself to what they must. After watching this over the years, it is actually with much trepidiation that I decided upon pursuing medicine.
And I remember a few nurses a ways back that reasoned, "If you count all the years of education in pursuing a doctorate in nursing, especially along with a NP, it's the same amount of time." But that couting of years is quite misleading. Total hours should be used, and what's more, you have to qualify them in a much different way. It's more apples to oranges than a few nurses wanted to admit. But I will say that these nurses didn't really work very closely with residents like many of us did. When you see how their work-life is day in and out, it's a totally different ball game.
Someone else said basically this somewhere else on SDN. Nurses take away from their own profession by stepping too far outside of what is within their realm.
So to me what needs to be done is that medicine must get more and more nurses and the GP to being willing to honestly evaluate the differences in education, residencies, certification, and practice. It might surprise you to know how many people will agree that one type of preparation does not equal another. If it needs to be, and it may if your fears are as soundly based as you think, this whole thing could be clarified with objective comparisions both quantitatively and qualitatively.
Forget the rhetoric and all the back and forth. Just let the objective comparative analysis speak for itself and get the data out repeatedly by massive media and public awareness. Eventually the harsh reality will have to kick in for people.
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I do not know where you are seeing or meeting such nurses, but most of the nurses I work with--advanced practice or not--would laugh at that attitude.
Again, it's apples to oranges, and every rational person or nurse I've worked with will outright admit it. Deans of major nursing schools and programs will admit it.
Again, not sure where you got this mentality, but I can assure you it does not represent the position of most nurses.
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I don't think nurses or PAs think they should make as much as doctors, but the point remains. A physician may make, let's say on average, $200,000. That's after years of medical school and residency, the fact that they work weekends and take call, and that they are medically liable for everything. And yet a nurse or a PA will make $100,000, which is actually not bad, considering the fact that they don't take call or work nights or weekends unless they want to, the nurse works three or four days a week, and there's essentially no direct liability. Sure, you can argue that they make "half" of what a doctor makes, but it's for about 1/10th of the work. It's the same reason people get upset at ER guys. It's not like ER guys are rolling in the dough, but relative to the amount of work they do, it's pretty obnoxious.
No liability for nurses??? Nurses can and have been sued for mistakes they have made. Its a different type of liability than than docs have, but then again, you are not really liable either because your attending is responsible for what you do. There have been cases where the nurse has taken the fall and the doctor relieved of liability if the mistake/injury has been shown to be the fault of the nurse and not the doctor. I am laughing at the fact you think we work weekends, nights and holidays because we choose to. All of the important things I have missed due to work weren't because I chose to be working that day/night/weekend.
1/10 of the work? You are comparing apples and oranges here. We have different roles, you can't compare the nurses work to yours. Patients stay in the hospital because they need nursing care. Otherwise, you would be operating and sending the patient directly home from the OR. If doctors didn't operate or admit sick patients to the hospital, we wouldn't have a job either. We depend on each other for the care of the patient. That is indeniable.
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You're right, it is apples and oranges. I won't disagree about that. But (and you'll take this as an insult, I'm sure), the physician side of things is the thinking part. The nursing side of things is just the carrying out of said orders. Now, I don't mean that makes it "inferior" in the sense that we need people to do it. Is their job important? Absolutely. But let's not play "hold hands and sing kumbayah" here. By the same token, the janitor is important. I mean, everyone's job is important in the hospital, other than maybe the administrators. We need the techs, you need the nursing assistants, everyone needs the transporters, and so on. We're all important. That doesn't mean our jobs are equally difficult or that we all should be making the same amount. That's my point. Hey, I'm glad that I don't have to change the diapers of some guy stooling all over himself. But if you told me I could make six figures doing it, I'd probably at least consider it if I was the average person.
Oh, and, no, nurses don't have liability. I mean, they do in a technical sense. But they insulate themselves from it with their documentation. That's all our nurses do all day. "I'm doing this because Dr. X told me so at 1:32 PM." Or "I called Dr. X and he told me to do that." Or "Notified Dr. X about this lab value." Nurses are in a position to put all of their responsibility on someone else. That's half of the reason they page everyone else. We all know that. It's no secret and nurses aren't clever. We all know they're asking "what was your name?" so they can document it, not so they can say hello in the hallway tomorrow.
Oh, and, no, nurses don't have liability. I mean, they do in a technical sense. But they insulate themselves from it with their documentation. That's all our nurses do all day. "I'm doing this because Dr. X told me so at 1:32 PM." Or "I called Dr. X and he told me to do that." Or "Notified Dr. X about this lab value." Nurses are in a position to put all of their responsibility on someone else. That's half of the reason they page everyone else. We all know that. It's no secret and nurses aren't clever. We all know they're asking "what was your name?" so they can document it, not so they can say hello in the hallway tomorrow.
I don't think anyone in their right mind would say that a nurse or any other person in the hospital should be making as much as doctors. A good friend of mine who was a resident at the time figured out that he was making something like $8.69 an hour. If nobody is disgusted by this, they should be. You know who makes more than both of us? Administrators who don't touch patients at all.
It is our legal responsibility to notify Dr. X when there is a change in condition for the patient or to clarify orders AND to document who we spoke to. If we do not and something happens to the patient, WE are liable. How could the court hold you liable for the patient crashing if you weren't on the floor/unit and didn't know about it? In the past, I have seen instances where the MD gave a verbal order and then when his order harmed the patient, he denied giving it. If I have your name and a witness to the verbal order, you cannot pin your mistake off on me. You should also get the name of the nurse you are giving a verbal order to, so if he/she doesn't do it or claims she never recieved it, you are protected as well.
The reason that nurses are held to legal standards is because we CAN think. If you ordered Gentamycin 180mg on a patient with renal failure and I gave it "just because the MD ordered it", I would be in a LOT of trouble for doing it. I could lose my license or get sued. That is not blindly following orders, that is an example of critical thinking.
If you think that all nurses do is clean Sh, than you really should spend some time watching what we actually do. You know what, it sucks to clean Sh, but I have compassion for the patients I care for, and I would not want my mother or yours for that matter, to stew in **** and develop a decubidi or UTI. Allowing patients who can't care for themself to have some dignity, is one of the most important things we all should be doing for patients who are hospitalized.
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If you read what I wrote, I said the same thing. But we're not talking about absolute salary comparisons. Like I said, it's how much you make relative to what you do. If you told a physician they could work for three days a week, no nights or weekends, no call, and minimal liability and the only catch would be that he could only make $120,000/year, it would be a stampede.
Again, agreed. But the point remains that what it legally does is move responsibility to the physician. Which is where it should be, I'm not saying otherwise. But if the physician, including the resident, shoulders the responsibility then my argument has always been that they make the rules. If they tell someone to do something, it should just be done. Period. There shouldn't be acceptance of "oh, nobody recorded vitals since yesterday" (which happens) or "this med wasn't given" (which happens) or "she didn't think it was necessary" (which happens), etc. And trust me, I've tried to document "nurse didn't give meds" and have been told to expunge that from the records by administrators.
I do, actually. There's a lot of work involved in getting patient walking or checking their skin for breakdown or even, yes, cleaning their "Sh." Like I said, it's all important. But a lot of nurses I know are basically just glorified moms for the patient. Which is great, I know patients like being pampered and babied and they develop great rapport with the nurses. I'm just saying that this is how a lot of nurses get by with not doing stuff. Like, they won't give a patient their meds on time, but they'll always be like "you want an extra pillow? I'll get you one, dear!" I'd prefer the patient got the meds on time, but that's just me.
If nurses aren't doing vitals or withholding meds (without a damn good reason) and not notifying the MD (and then give them anyway if they are instructed to do so and its safe for the patient) they should get in trouble if they are reported to administration. I wonder where they get these nurses you work with from?? There is also a big difference between a nurse withholding meds because its inconvienant for them, than holding meds because it would harm the patient.
Yeah, you can't write anything derogatory in the medical records about the nurse, and we cannot write anything about you. This puts the hospital in a position to get sued. A 4th year rotating ER resident did that to one of the nurses years ago because she didn't do the (non-emergent) order as he was saying it, and the chairman called his director. This guy almost didn't graduate because of it.
Only factual information in a non-accusatory manner can be documented. If Dr. X is being paged because his pt is coding, I cannot write Dr. X paged 3 times and refuses to call back, but I can write, MD paged at 1200, 1205 1210, awaiting response. Actually, the docs at my hospital had an inservice on proper documentation due to problems with accusatory documentation when calling consults or if the consults were trying to get out of doing them.
They shouldn't be writing that either, that is accusatory. The resident they are paging might not even be in the hospital, and documenting that way gives the impression that they aren't calling back because they don't want to. Besides, we all need to document in our notes that we did everything we can to make sure the problem is addressed. You can't just write resident paged, didn't respond and leave it at that. If the patient dies, its the nurses fault.
There is supposed to be policies in place for a chain of command. If the patient has a problem/emergency and the resident who is covering doesn't answer, then you call the floor and ask what resident is covering that patient now, or call the surgical team the patient is admitted to. If that yields no results, we call the chief and then the attending if the chief doesn't answer or if he/she asks us to.
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Here is a fantastic article worth reading:
The Doctor of Nursing Practice: Recognizing a Need or Graying the Line Between Doctor and Nurse?
For nurses in DNP denial - By the year 2015, if you want to become a nurse practitioner you will have to go through a DNP program.
Resistance is futile!
The Doctor of Nursing Practice: Recognizing a Need or Graying the Line Between Doctor and Nurse?
For nurses in DNP denial - By the year 2015, if you want to become a nurse practitioner you will have to go through a DNP program.
Resistance is futile!
With regard to one of the above poster's in their erroneous assumption that nursing is not a "thinking" profession, I don't know what to say. That is entirely outlandish.
You have NOT been through and completed a strong nursing program, nor have you functioned as nurse or have worked in an area where critical thinking and judgment of nurses goes far beyond use of algorhithms. I have, so I know that such thinking is imperative, especially in these areas. Also, the use of alorhithms is a whole other argument, b/c they are used MUCH in medicine as well.
Nevertheless, believe as you like. But your false beliefs that you have generalized toward many individuals and a whole profession will NOT serve you or your patients well now or in the future.
I'm done arguing over the DNP thing. Everyone that has some insight knows that nursing is a different art and applied science than medicine, period, end of story.
Again, most nurses, advanced practice or not, are in complete agreement about most physicians' general education and post med school education, etc. We freely give place and credit where it is due and are completely fine with it. When a nurse, for example, wishes to move in a different direction--> medicine, he or she pursues the path of medical school. And that is the way it should be.
I'd say keep an eye on this DNP thing, but don't get bent out of shape over it. The more obvious concerns are definitely with regard to healthcare and appropriate reimbursement and things like tort reform.
I honestly feel that some of this excessive concern about advanced practice nurses is just a means to allow for more undue disrespect and negativity towards nurses and nursing--and that it's a means to rationalize and justify kicking nursing, which, and this is not without significance, is a female-dominated profession.
My concern is that it is teaching (and perpetuating the practice of) med students and residents, etc to feel justified in seeing nursing as some sort of rival, and it encourages unnecessary antagonism.
That's my opinion, and yes, I'm entitled to it.
Be aware of this "midlevel creep," but don't be unduly offensive or defensive or antagonistic towards others in another profession--or towards those that function as advanced practice nursing b/c of it.
If it in fact does become a major concern, which remains to be seen, there are better ways to handle it.
I'm just saying. . .
You have NOT been through and completed a strong nursing program, nor have you functioned as nurse or have worked in an area where critical thinking and judgment of nurses goes far beyond use of algorhithms. I have, so I know that such thinking is imperative, especially in these areas. Also, the use of alorhithms is a whole other argument, b/c they are used MUCH in medicine as well.
Nevertheless, believe as you like. But your false beliefs that you have generalized toward many individuals and a whole profession will NOT serve you or your patients well now or in the future.
I'm done arguing over the DNP thing. Everyone that has some insight knows that nursing is a different art and applied science than medicine, period, end of story.
Again, most nurses, advanced practice or not, are in complete agreement about most physicians' general education and post med school education, etc. We freely give place and credit where it is due and are completely fine with it. When a nurse, for example, wishes to move in a different direction--> medicine, he or she pursues the path of medical school. And that is the way it should be.
I'd say keep an eye on this DNP thing, but don't get bent out of shape over it. The more obvious concerns are definitely with regard to healthcare and appropriate reimbursement and things like tort reform.
I honestly feel that some of this excessive concern about advanced practice nurses is just a means to allow for more undue disrespect and negativity towards nurses and nursing--and that it's a means to rationalize and justify kicking nursing, which, and this is not without significance, is a female-dominated profession.
My concern is that it is teaching (and perpetuating the practice of) med students and residents, etc to feel justified in seeing nursing as some sort of rival, and it encourages unnecessary antagonism.
That's my opinion, and yes, I'm entitled to it.
Be aware of this "midlevel creep," but don't be unduly offensive or defensive or antagonistic towards others in another profession--or towards those that function as advanced practice nursing b/c of it.
If it in fact does become a major concern, which remains to be seen, there are better ways to handle it.
I'm just saying. . .
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You are certainly entitled to your opinion, but I disagree with this part.
DNPs are the ones who publicly claim they are better than physicians. Physicians are merely responding. Nurses are the ones creating antagonism not physicians. You know medical training is rigorous and long. So you also must know that to have someone say they can do what physicians do better with much less training is insulting and dangerous.
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Can people please stop responding to the nursing trolls. They've already caused an otherwise decent thread to get locked and they've sufficiently derailed this one as well. Just stop responding to them and maybe they'll go away; there has been nothing substantive gained by their presence here.
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Despite the fact that this is a residency forum, which means as a medical student, I am myself a guest on this forum - the nurses will continue to post on this no matter what you write. This thread is going to be closed - it is unavoidable. The sad thing is - I've enjoyed reading posts on the residency forum for some time now, but this nursing-troll thing is relatively new. I wish it would stop. Heaven forbid a resident talks about their life as a resident experiencing nurses masquerading as doctors....or so it seems.
Click on the
For the love of all that's good, that was totally unnecessary.
And the latter statements in particular reinforce what I said early. Thanks for making my points more obvious.
Don't worry about me. I have NO intention of returning to this thread, especially in light of some attitudes. Thank God not everyone thinks this way.
And stop callling people trolls out of hand like that. Apparently you don't understand what the true definition of troll is; but I guess it's an easy term to flip out when all reason fails and to get away with. In my view, people that falsely refer to folks as trolls should be reported. Way to try to use a system unfairly in your favor.
So by all means, click on report thread for differing responses that yours. Thanks it fact for making that statement. Real colors and depth are shown by such statements.
Comment all you'd like. I'm done with this and will NOT return to this thread. Waste your time and spin your wheels on lesser priority things if you want.
Again, those comments were totally uncalled for.
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I don't think many of us think you're a troll, just unfortunately holding a widely different opinion.
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jl...please. Your voluminous posts haven't changed any minds and have, if anything, cost you (and others) the good-will that's generally extended toward nurses who post here. Your war of words may win you a battle here and there, but you are going to lose this war.
Think about the fact that this could be a site closed to nurses, period. I wouldn't want to see that; I've enjoyed getting to know many of the posters here. I've learned a thing or two along the way. Please think about how your actions could affect others.
For the record, my opinion on DNPs hasn't changed: Won't go to one, wouldn't want to be one.
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I would like to remind everyone that it was explicitly stated in the, unfortunately, closed thread that nurse are welcome to post here as long as they are respectful of the docs' (be they future, training, or practicing) right to post about their experiences in what is, ultimately, a forum for them. This also entails allowing for some griping and venting at times. 99% of the time even when heated our venting is directed at a relatively small segment of the addressed group at large (i.e. venting about stupid nurse calls is about the nurse who makes stupid calls, not the vast majority who make intelligent calls and are known for saving resident bacon at times). Don't interpret a broad brush when there isn't one. However if a broad brush truly is used and something *****ic is said (a la a few of the posts above) then it isn't necessarily trolling just because a nurse (who also happens to be a pre med) calls it for the steaming pile of crap that it is. I would ask that people on both sides of this aisle use some of the critical thinking that is (supposed to be) endemic to both professions.
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You ever hear the phrase, "keep your friends close and your enemies closer?" I made the final comment that caused the "stupid calls from nurses" thread to be closed. While I am a "smart*****" and my comment was tongue in cheek, if you think about it, it also had a point. I have more free time than a resident and I think Obama sucks but I don't waste 5 minutes of my time "venting" on something I can't change.
Most nurses know that our training is not as extensive as yours. Most of us do not agree with the DNP and I doubt many who have the degree are standing on the street corner saying they are equal to physicians. I do think the degree is valid for some people's goals. I've taken one DNP financial course and it was comparable to my MBA courses. I can see it as being valuable for someone who wanted to affect change in healthcare, ie. start a clinic of some sort or some healthcare project. I don't see it as adding much in the way of clinical practice.
So, in short, you might gain something by listening. Yes, nursing is powerful. Have you ever wondered why?
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Word.
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Interesting points made in the Miller JD article above.
One in particular is kind of amusing: It does seem that "less is more" is a repeated mantra used to boast how NPs are miraculously "equal or superior" in quality compared to MDs despite (or perhaps because of?) their significantly less intensive education.
So if all NPs are required to pursue a doctorate degree (however flimsy), does that not potentially reduce the magic of "less is more" and contradict the entire argument that the additional education is for all intents and purposes superfluous?
One in particular is kind of amusing: It does seem that "less is more" is a repeated mantra used to boast how NPs are miraculously "equal or superior" in quality compared to MDs despite (or perhaps because of?) their significantly less intensive education.
So if all NPs are required to pursue a doctorate degree (however flimsy), does that not potentially reduce the magic of "less is more" and contradict the entire argument that the additional education is for all intents and purposes superfluous?
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And this EXACTLY why nursing is important - allowing patients to maintain their dignity. Furthermore, this is exactly where "advanced practice nursing" (whatever that means) takes away from actual patient care. Most docs would love to make sure that their patients are getting out of bed and walking around, getting enough pain control, being cleaned up when they've soiled their sheets, etc. As a medical student I had many patients who I would have liked to have spent more time with, and I've definitely done "compassionate" things that would more traditionally be considered the role of a nurse (e.g. cleaning up an uncomfortable patient's soiled sheets when her nurse had to assist another patient, feeding an elderly patient who could not feed himself, fetching warm blankets and pillows, standing at the head of the bed to talk to and calm a patient during a painful/frightening procedure, etc.). But this is just not possible when you have a list of 25-40 patients for one team (meaning 1 attending) and you need to come up with assessments and plans for all of them. You can't hand-feed Mr. Jones or sponge-bathe Mrs. Brown because you still have 10 follow-ups and 3 new consults to see, and there are 2 new patients in the ED. This is why nurses are there to be the "effector arms." This is also why, at the hospitals where I have rotated, each nurse has a cap on the number of patients that they can have at any given time (usually 1:1 or 1:2 in the ICUs, and 1:4 on the floors; some floors may be 1:6 or more depending on the level of care necessary). If I only had 6 or 8 or 10 patients on my list at any given time, didn't have to run around to multiple floors/wings/hospitals, and wasn't the one doing the assessments and making the plans for them (which, in itself often requires extensive research and background reading), I'd be able to spend all day talking to these patients, bringing them things that they needed, monitoring them, and making sure they were properly cleaned, fed, and medicated.
I don't understand why some nurses aren't pleased and content with this role, and instead are trying to pose as medical doctors. Being an "effector arm" and allowing patients to maintain their dignity are two of the key roles of nurses in a hospital. But nobody wants to be a floor/unit nurse anymore - everybody wants to be a Nurse Practitioner, so that they can diagnose and treat without having to "clean ****," administer medications, or carry out doctor's orders anymore. Apparently nursing assistants can pick up the slack and do all the grunt work. If you don't want to be a nurse anymore, and would rather be a doctor, then that's fine - go be a doctor. But the answer isn't to come up with some pseudo-equivalent degree. The answer is to go to medical school and satisfy all the requirements to become a medical doctor, like everyone else.
The status of the future of nursing, as I have experienced it, is very sad and very sobering. I recently gave a talk about cardiovascular disease to a group of about 25 students at a local college. 7 of the students were in the school of nursing. 5 of them planned to be NPs. If everyone's going to NP school to become "doctors," who's going to be left on the floors?
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Click on theunder Mr./Ms. Nurse Troll's username and report them. That's the best way to get rid of them.
.. or you could also...
The NP role the way it stands now, is to work with doctors in order to provide care to patients in their respective roles. The DNP's who you see on TV don't represent the vast majority of the NP's out there, but that issue has been discussed ad nausem.
I think its great that you have done those things for patients, even though you have all those other things to do. I bet those patients never forgot how kind you were to them, and appreciate those things more than you know. It's clearly not your job to clean a bed, but I think the patients really do feel like they are being treated like a human being when we all do the little things sometimes, like pass them the pitcher of water they can't reach on the bedside table or fix the pillow behind their back. It takes all of 2 seconds to do.
I really think that you are misunderstanding what I mean when I say we should all do things that allow the patient to maintain some dignity. When patients are admitted to the hospital, they have little control over their care, they have little to no privacy, and often anxious or scared.
Here are some of the biggest offenses I notice that BOTH doctors and nurses alike do that don't maintain dignity for the patient:
Go into the room and pull open the curtain without at least warning the patient that you are there.
Examining the patient, especially if you are going to be exposing them, without closing the curtain or the door to the room, and allowing an audience of med students/residents/whoever to watch without asking the patient's permission first if they are alert. I mean, even if you have to do a pelvic exam, putting a blanket over their lap makes the woman feel more comfortable without really getting in the way of the exam.
Making loud comments about odor or other uncontrollable bodily functions in the room. If the patient has melana or an infected wound, its going to stink to high holy heaven. If they have c-diff and have uncontrollable diarrhea, they can't help it. I'm know if the patient is alert and they hear people comment on how disgusting it smells embarrasses the patient and IMO, inappropriate.
Making comments about the patient's appearance IN FRONT OF THE PATIENT is inappropriate. You wouldn't believe how many times I have seen this. Its hurtful to the patient.
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Im new here, but I've read some very informative and intelligent things written by nurses, most of who are apparently either in medical school of applying. Why do you call it a troll if they disagree with you and your tone?
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Get a load of this lady who gets a doctorate in philosophy just so people call her Dr Teri Wurmser in her admin position, so transparent, oh and from adelphia
http://www.njsna.org/displaycommon.cfm?an=1&subarticlenbr=336
http://www.njsna.org/displaycommon.cfm?an=1&subarticlenbr=336
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The vice first lady has an inferiority complex as well
http://articles.latimes.com/2009/feb/02/nation/na-dr-jill-biden2
She has made quite an issue demanding that all press releases address her as "dr".
Pretty sure she's not demanding that in a health care setting. Do you not see the difference?
In Hospital, Dr = Physician.
In a Clinic, Dr = Physician.
In a Dentists Office, Dr = Dentist.
In a Vet's Office, Dr = Veterinarian.
In an academic setting, Dr = PhD.
If you start intermingling them, it's going to cause confusion.
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I just can't believe you think physicians should not be up in arms about this because you "say" the vast majority of NPs out there aren't represented by this thinking.
Let me spell this out:
- already completely happened with anesthesiology
- already completely happened with obgyn
- currently allowed independent practice in 28 states (even if not many NPs do, they are allowed to, so likely more and more will)
- pushing for equal reimbursement everywhere despite literally a fraction of the training
HOW in god's name would we NOT think this is a major problem. Even if most DNPs/NPs don't think like this the leadership certainly does. It's so clear-cut (full take-over mode in 2 fields already) that I don't even understand how you can argue? It's as if a robbery is being committed in front of our very eyes and you are saying that it's not happening.
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You guys are wasting your time arguing with nurses and PAs about the issue. I suggest you just ignore their posts. They have a clear motive to support that movement, even if they personally are uninterested in being called "doctors." You're arguing with them as if they're just these bystanders who are objective and then you get frustrated because they don't see what's right in front of their eyes. They don't want to see it. They could care less.
Physicians say that the AMA does not represent most doctors in this country. I am saying that these DNP's do not represent the overwhelming majority of NP's. EVERYONE I know who is in NP school plans to work with MD's. Anyone I have ever heard of who is going for DNP are getting it because they are going into academia, or are getting it in the event that they make the DNP required to do the same thing they are doing now.
As far as CRNA's go, I know that in the NYC/NJ area (I can't speak for other areas of the country), hospitals and private practices are laying them off because they are costing just as much to employ as anesthesiologists do. They have capped themselves out, and are now jobless. I think its pretty much common sense that if it costs the same or even slightly higher to hire a board certified anesthesiologist, that they will win out over CRNA anyday.
Women have sought out midwives long before the DNP degree was even created. This is nothing new. There is a large movement out there of women who are into childbirth with little to no MD intervention. Right or wrong, crazy or not, they are out there and they are choosing what providers to go to.
Independant practice does not mean equal scope of practice. I don't think that ever will or should happen. Even in a state with independant practice, they still must work in collaboration with an MD.
Don't worry about what these so called leaders are saying. If the 99% of NP's are not going for it because we don't want to risk our license or patient injury by doing things we were not trained for, we will not vote for these changes!!!
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Very true, I was just stating that the desire for the title is so ubiquitous. Everyone wants to be called Dr. It has kind of lost its effect.
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I hear what you're saying about the majority of NPs not being for the current trend the leadership is setting. However, I have never seen anything beyond anonymous posts on forums suggesting this. How am I to believe that the majority of NPs don't support what their leadership is doing when this "majority" always appears to be silent? You also keep saying that everyone you know plans to practice under supervision. That doesn't really mean anything though. I could say every NP I know wants to practice independently, with an equivalent scope of practice as physicians. Who's right then? You or me? The plural of anecdote is not data. The only thing that we, and the public, currently have to go by regarding on what NPs want to do is what's being put out by the leadership because it's the only thing we see. I find it very hard to believe that 99% of NPs are against the current movement when I see none of this "majority" standing up to their leadership.
God help me, I said I was not interested in replying again in this thread, but this response was so unfair I felt it important to do so.
Make NO mistake about it. I do NOT support in any way, shape, or form DNPs or anyone else taking the place of DOs or MDs.
And it has nothing at all to do with the fact that I'm a RN. Neither does it have anything to do with the fact that I am pre-med. Nothing.
I am sincerely working hard to be objective about this issue. I still contend that physicians keep their eyes on it; but I just have a hard time buying that the GP will embrace non-physicians as physicians.
Look, a kangaroo is a kangaroo and is NOT a horse. Oversimplification? Perhaps a little; but even with strong lobbying, I will tell you once again that nursing is very much a house divided against itself--and in contrast to medicine is NOT NEARLY as unified--AMA or not.
Please do NOT assume just b/c someone is a nurse that they cannot strive to be more objective about this issue.
By the way, may I ask if you have strived to look at things from say the NP's perspective? NO. I am NOT asking you to agree with those that are pushing for this whole DNP thing. But I think you need to step outside of your own agendas and biases in order to consider some things from their POV.
Again, I am in no way supporting the idea or practice that any kind of midlevel should usurp the role, function, and place of physicians--and, again, if I were not pre-med I would still NOT support such a thing. It's an issue of logic to me. Kangaroo = kangaroo, and horse = horse, period.
People can be logical about this without being unduly pressed by various biases--as in "guilt by association." I am also pre-med, does that necessarily mean that my lack of support for medical, professional usurpation by midlevel providers is such merely b/c of my desire to become a physician? It may seem that way, but it is not. As for right now, yes. I am a nurse. NO. I do NOT think non-physicians should takeover or take the role of physicians. Rationale once more: Kangaroo = kangaroo, and horse = horse, period. The strict requirements and education and exposure necessary for medical school, as well as the post-medical school training and education and board certification are necessarily rigorous and pretty well-structured. It is illogical to make non-physician "physicians" in the sense of practice without them following the same rigid requirements. This protects patients and the general public, hands down. So once more, it is an issue of what is most logical to me--and what I believe patients and the GP, and those that are supposed to look out for the GP will allow.
glade, seriously, your comment was unfair and unfounded in that your are presuming those that are nurses are in opposition to you.
You want to see the reality of the situation? OK. Ask how many nurses or even NPs would be OK with their kids seeing midlevels for serious issues? Ask how many of us don't care about how closely the anesthesiologist is supervising the CRNA when our children are about to undergo surgery.
Ask how we feel about high risk OB pts sticking primariy with midwives. As a high risk OB patient myself, I will tell you that this is a total no-brainer!
And I know I'll probably tick some NPs and PAs off, but just ask how many of us would be totally OK with only them seeing then if one of our family members come into the ED with unstable angina without them at least also seeing a reputable physician for this. When my dad came into the ED with severe anemia, you can bet your labcoat that not only a bonafide ED physician say and managed him, but also that a bonafide hemonc physician saw after I looked at my dad's labs and such. I wasn't wasting any freaking time, and I was dead serious.
You will find most nurses will, hands down, say they want reputable physicians evaluating their family members or these kinds of patients. Poll even the nurses on this board or even those at say allnurses. We want the reputable, knowledgeable, caring, insightful, well-educated DO or MD. That is the reality test.
I am not 100% certain, and NY can speak for herself/himself, but seriously, I am not getting that he/she supports this either.
Please don't throw unfair refuge into the discussion pot. Not eveyone evaluates things primarily controlled by some bias. Some of us were taught logic and reasoning skills and can separate ourselves from undue influences and biases.
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is becoming a nurse harder than becoming a doctor?
can doctors perform the various tasks of nurses? (and vice versa)
can doctors perform the various tasks of nurses? (and vice versa)
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No
Yes, but what physician would want to. Changing bedpans, linens, pushing meds, etc., etc. ----- EFF THAT NOISE!
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If you want to be a nurse, go to nursing school.
If you want to be a doctor, go to medical school.
If you want to be a mid-level provider, go to PA school (if you're more into the medical model) or NP school (if you're more into the nursing model).
The proponents of the DNP "doctor" argument want a fourth option where you get all three in one - you get to be a nurse, a doctor (not a medical doctor though, a nursing doctor...) and a mid-level provider all in one !
If you want to be a doctor, go to medical school.
If you want to be a mid-level provider, go to PA school (if you're more into the medical model) or NP school (if you're more into the nursing model).
The proponents of the DNP "doctor" argument want a fourth option where you get all three in one - you get to be a nurse, a doctor (not a medical doctor though, a nursing doctor...) and a mid-level provider all in one !
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Recognize changes in assessment that indicate early signs of decompensation, responding in the appropriate manner when that occurs, adjusting medications and other therapy based on assessment findings, making decisions whether medications or other therapies are appropriate in the first place, assuaging fears, teaching, providing comfort, managing hygiene, dealing with abusive behaviors of crazy and/or entitled patients and/or families, making sure the hospital doesn't lose accreditation (and therefore income) by making sure that regulations are followed, etc, etc.
Yeah, clearly not everyone has what it takes to be a rockstar nurse.
Nice and very ____ true. If you a person hasn't done it--or if they have done it and not fully appreciated and practiced with the full holistic model, the probably won't get it.
But obviously it has its limits.
I mean look at both of us RP. We're pre-med, so . . .
I think nursing needs to come out and clarify this DNP thing in specifics, or they are going to have one heck of a war on their hands.
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