Useless wankers at the hospital

[All4MyDaughter]

It would be an issue if absolutely everybody went into pediatrics, and there were zero specialists in geriatrics, as it is with the "life specialist" "profession."

Again, the argument is on the roots of this particular field. If they are indeed so important, why are "life specialist" services not extended to senior citizens awaiting surgery? Maybe it's because it's a ridiculous field on its face? Maybe its because it was invented solely to let these child life specialists feel good about themselves and get paid for doing volunteers' work?

Also, regarding the invented term "play therapy", I'll just comment that it is amazing how much some people will over-think everything. Even something as basic as child's play.

Finally, I disagree with your basic premise stated elsewhere that "all professions deserve equal respect." Nothing could be further than the truth. If you wish to ban me and others for disagreeing with you, as you have threatened, then get busy banning and be sure to revise the ToS to make disagreeing with All4MyDaughter a bannable offense. I find such heavy-handed threats degrading to both you and to SDN.

As far as I can tell, ForbiddenComma, we're just having a discussion here. You think I'm going to ban you because you don't like child-life specialists?

Seriously, I'm allowed to participate in discussions on this site and I'm allowed to disagree with people (without it becoming a big deal), which is what is happening here. Let's not make this thread about anything more than what it is, which is the utility of certain auxiliary professions in the clinical setting.

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[f_w]

As far as I can tell, ForbiddenComma, we're just having a discussion here. You think I'm going to ban you because you don't like child-life specialists?

I think ForbiddenComma just doesn't like kids....

(talk about a thread that has turned into a idle self pleasuring of a few posters.)

 

[All4MyDaughter]

I think ForbiddenComma just doesn't like kids....

(talk about a thread that has turned into a idle self pleasuring of a few posters.)

Not liking kids that much is something I could agree with FC on. I like *my* child and I like my nieces/nephews/godchildren (and like to send them back to their parents at the end of the day!) but the thought of working with kids every day gives me hives. I much prefer the senior citizens!

 

[Tired]

Why is this bad for some of the academic medical centers? The nurses have critical patients to care to, so having someone that covers most if not all of the floors on the daily basis (almost social worker like) helps the nurses and obvious is effective for the work flow.

It's amazing to me that we can honestly suggest rationing health care based on ability to pay, or allowing bean counters to dictate what tests are "indicated", but no one thinks twice about paying someone real actual money to play with children.

Why is it a bad thing at academic medical centers? Because it's a total waste of f-ing money, that's why. If the nurses are busy and need a "helper" to improve the "work flow", then hire a g*ddamn nursing assistant for ten bucks an hour, not some overeducated babysitter for $50,000 a year.

Pretend all you want about this "valuable" service they provide. They play with kids for a living. It's not something worth paying for (and yes, we are all paying for it indirectly). There are a million high school kids out there who would volunteer to do it for free, and I promise you half of them would do a better job.

 

[Aceofspades]

This thread has been one of the funniest threads I've read in a while

I must make a comment about the child life specialist. I don't actually have any experience with them so I cannot attest as to whether they are overpaid babysitters or actual "specialists." What I can say is that I doubt many people will actually pay for this service if the hospitals ran like any other business with a transparent pricing model. If people knew that that 2 hour play session was going to cost them X amount of money they just wouldn't pay. Just look a the amount of parents who neglect their kids entering into the hospital system. And you seriously think they will pay for playtime?

My real comment is about the delegation of responsibilities to others. Some may see this as a good idea, but it really does create some problems.

First, you lose the ability to practice with true autonomy within your profession/specialty. After you delegate all the "minor" duties to others you are at risk of forgetting how to do common things and being forced to sit on your hands while you wait for other hospital wankers to do what was once part of your job. Congratulations, you have now become a wanker.

Secondly, once you delegate your lower responsibilities away to midlevels you have essentially validated their importance while lessening the perception of your own importance and skills. The midlevels will now say "If Dr. X is so smart why can't he draw his own blood"? Or "Dr. Y doesn't do anything! I'm the one who does all the work".

Thirdly, you limit your patient interaction (in some cases) and now the patients see more of Dr. DNP than you. Who do you expect them to be closer to? Who do you expect them to value more? Dr. DNP may even know more about your patient than you do.

Lastly, you dig your own grave by inviting midlevels to fight for more clinical rights at the detriment to your own clinical rights. Do you really think they will just be happy doing midlevel work? Some will, but many will fight for more. And guess what, because of points 2 and 3 they will have a better perception in society. A politician will come along and agree, overriding the doctor's decisions and recommendations in the blink of an eye.

This is the same problem that is slowly brewing in the dental field. You have Advanced Dental Hygienist (ADH) starting to branch out of teeth cleaning into the "lower" responsibilities of dentists such as cavity fillings. Anyone should be able to predict where this will go, but some dentists think that this is a good thing because it will relieve them of lower responsibilities and allow them to focus on more profitable procedures. Sure, this is what will happen at first... until the ADH decides to expand their clinical scope.

 

[MassEDRN]

um


































shut up

 

[MassEDRN]

You're right, doctors don't have enough to do. We should definitely take back the teaching responsibilities and coordination of O2 at home...

Let the nurses take that crap. Maybe we can convince the midlevel providers that those responsibilities are all it means to be an MD and we can get them to do it too, instead of making half-a$$ed diagnoses and writing scripts willy-nilly.

that's where nurse case managers can "take care of that crap." I'm not coordinating that. Thank god there are case managers to organize that - or social services.

 

[MassEDRN]

I thought you were serious until I saw this. How much time do you want to spend telling patients how to use an inhaler, how to inject themselves, and then reading all of the precautions you have already written on the discharge instructions?

clinical nurse educators, in the hospital, educate the staff and keep everything in line with the facility requirements.... the floor or unit nurse is responsible for everything else required related to d/c teaching... unless it's related to a specific illness that has a specialist in-house (Diabetes, wound care, RT for IS, etc).

 

[MassEDRN]

Great thread.

Its bad enough that these people are sucking up paychecks, whats even worse is that most of these scoundrels are trying to change hte law to get reimbursed by Medicare/Medicaid for their "services"

That represents a "clear and present danger" to us doctors. The reason why is because whenever these "providers" get the ability to bill Medicare, their reimbursements come DIRECTLY out of doctors paychecks.

Its all the same pool of money. As the number of "providers" billing Medicare per patient increases, the amount of money that each doctor gets per patient DECREASES.

In the future, the phrase that the media likes to use, "Medicare payments to doctors" no longer has any meaning, because its really money being paid out to a bunch of people, most of them NOT being doctors.

so you're upset that these "providers" (I'm assuming, you believe a Nurse Prac is not a provider) are taking "your" money from Medicare/Medicaid?

Hate the nursing profession much?

Must I really remind one that nurses are the backbone of the healthcare world...??? Best to change that attitude... you really want nurses as your ally in this healthcare world....

 

[MassEDRN]

Since my hospital may use different titles for some of these positions I won't quote directly from the OP but...

Case Coordinator and Social Worker While I agree that a lazy Case Coordinator is not only a drain on the hospital but someone who can actively interfere with you getting your job done (one individual here springs to mind) by and large I find these people to be hardworking, under-appreciated members of the staff who do great work helping us get patients OTD faster and to a place with the appropriate level of care.

Physical Therapy Again, I've had a run-in or two with PT that was irritating, but by and large these are very helpful people when consulted correctly. The problem is they are so rarely consulted correctly. At my hospital there are pre-printed admit forms that have a box for "PT/OT to eval/treat." What the hell is that? First of all PT and OT are not at all the same thing and second of all think of how irritating is it for you when you're on a consult service and some one calls you to "come on by and take a look at this guy" without really saying what's wrong with them. What if every one of your consults was like that? Ridiculous. When I have a focused issue I'd like the PTs to address I don't even have a place on the form to tell them about it.

Clinical Pharmacist Good ones are worth their weight in gold I think. On ID consults our clinical pharm team had information about patterns of resistance in bacteria specific to this hospital. As in, "the acinetobacter the lab has been isolating recently is often only sensitive to colistin" or "our recent MRSA isolates often require a vanc MIC of 1.5 to 2 so we could consider dapto." Also very useful in the ICU, and on the floor they are usually more in the background but when they do chip in it's usually a useful suggestion.


Just want to balance out this thread, I've had good experiences working with most of the positions you've singled out and I don't think it's fair to malign their whole profession just because some individuals in these positions are, indeed, "useless wankers." I'm sure we've all seen plenty of individual residents who are lazy, incompetent, un-productive, and useless but we wouldn't want our hard work belittled just because they suck...

good responses.

 

[MassEDRN]

But that's the thing.

1) Even if their jobs disappeared, it wouldn't necessarily fall on YOUR shoulders.

For instance, "Child Life Specialist"? What, a pre-med student looking for a good volunteer opportunity to boost their app couldn't play with some kids? How hard is it? Heck, I'd love to do that. And it sounds like the PERFECT job for your local pre-med society at your local college.

After all, how many threads are there over in pre-allo looking for "good clinical volunteering opportunities"? Dozens. Maybe hundreds. Well, there you have it. Go play with sick kids - enrich your life and boost your app. And save the hospital 60K a year.

2) Guess what? These jobs ARE there...and yet their responsibilities STILL fall on your shoulders!!!

Wait until your community internal med rotation. The social worker isn't being speedy about sending Mr. Jones to sub-acute rehab? The casemanager has been AWOL for the past 2 days while Mrs. Smith is waiting for a bed at her SNF? Guess who gets to make a ton of phone calls to every sub-acute rehab center in a 60 mile radius? Guess who gets to wrangle with the manager of the nearby SNF? THAT'S RIGHT!! THE MED STUDENT!!!

Why are THEY getting paid, when I did so much of THEIR work? The good ones are fantastic, and deserve to be appreciated - because some of their coworkers, frankly, suck at their jobs.

"For instance, "Child Life Specialist"? What, a pre-med student looking for a good volunteer opportunity to boost their app couldn't play with some kids? How hard is it? Heck, I'd love to do that." Obviously you don't have kids... or have had kids over to your house... it's not easy, in fact I am sometimes quite happy to go to work to get away from the chaos of the kids.

I haven't worked at a facility with med students, so I can't say what you all accomplish.... but it's all great experience if you have to make those phone calls... it will help you appreciate what those in their positions do for you when you're the one barking the orders.

 

[MassEDRN]

It was actually for a renal case, a complicated one at that... so yeah we needed that EM report.

Not too long ago, doctors were trained how to do IVs, run labs and that sort of thing. Now, we are helpless without the IV team and phebotomists. Sure that's not a problem at a big hospital (not usually anyway) but what if you are out in the boondocks? What if you're with Doctors Without Borders? What if you're in the military? What if you are with an ambulance crew or flight med crew? What if the nurses or techs go on strike? What if there's another Katrina or 9/11? Do you really want to be a useless wanker when your patient just needs fluids?

Or what if you just do it to help out, when the RNs are overworked or the slacker phlebotomist isn't showing up until 10 am?

I could go on, but the main thing is, I personally don't want gaps and limitations in my medical training like that. Even if I never need to start an IV for my entire career, I want to know that I can.

yep, I agree docs should know how to start IV's, get labs... if you can place a triple lumen, an EJ, etc., you should know how to start an IV line... any nurse will provide you the opportunity to start that line and draw labs... ANY nurse!

 

[Josh L.Ac.]

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[MassEDRN]

Im a Registered Respiratory Therapist on a Rapid Response Team at a Philly Trauma hospital. I take offense to the Insults. I like running around and scaring families. Don't take that away from me. Its the highlight of my day.I love bossing around Med students,nursing students, all students LOL. Well now that im about to become a med student..I hope karma doesn't come back and bite me in the butt. Last time i checked its not illegal to Scare people is it?

yes, karma will get you.

 

[MassEDRN]

The common misperception is that the 'n' stands for 'nurse'. In reality, it stands for that political group ruling most of europe in the 30s which you cannot mention in a usenet thread without risking the end of the thread.

 

[MassEDRN]

I had a patient with 3 negative smears for TB, so I opened their door and took the masks away. The nurses all scurried about and generally made a bunch of noise. And I was like "huh? i cleared them". And then they said "oh no, you can't do that! There's a procedure and everything!" I'm like...ok, they don't have TB. End of story. Jesus christ.

As a corollary to this, it supports my general idea that liability has turned everyone into douchebags.

This is what happens in a litigious society. Completely backwards, nutso sh.t

I agree.

 

[MassEDRN]

I just explained many of the things I think nurses should do.

What nurses should do:
Check vitals, first line to monitor patients, do basic procedures (such as administration of oxygen, blood draws, catheter insertion, starting IVs, etc...), dispense medication, attend to patient's basic moment to moment needs (anything from basic wound care to getting a glass of water), enact and double check physician orders, etc...

At my hospital, atleast 1/2 of this list is done by someone else, and we're cash strapped. Is there some other philosophy of what nurses should do that I'm missing?

What's not on the list:

Delegating all responsibility so that you can talk, check e-mail, and then suddenly grab all of the charts 20 minutes before shift change to jot down the vitals that your assistant took from whatever random piece of paper they are written on. That's not everyone, and I'm not intending it to be. It is however, all that's left if the first list is delegated to a bunch of other people.

Ahem: provide a glass of water? Last I checked I was not a glorified nurse's aide.... it is precisely this type of attitude of nursing that sets the profession back - VS are among those listed for CNA's as well, along with foley's, bedpan placements, bed-making...

Here's a summary of an ER nurse, written so well by David F. Baehren, M.D. ACEP News, September 2006:

"We usually look afar for heroes and role models, and in doing so overlook a group of professionals who live and work in our midst: nurses. And not just any kind of nurse: the emergency nurse. There are plenty of people involved in emergency care, and no emergency department could function without all of these people working as a team. But it is the emergency nurse who shoulders the weight of patient care. Without these modern-day heroes, individually and collectively we would be in quite a pinch.

This unique breed of men and women are the lock stitch in the fabric of our health care safety net. Their job is a physical, emotional, and intellectual challenge. Who helped the paramedics lift the last 300-pound patient who came in? Who took the verbal lashing from the curmudgeon giving admitting orders over the phone? Who came to tell you that the guy you ordered the nitro drip for is taking Viagra?

The emergency nurse has the thankless job of sitting in triage while both the long and the short buses unload at once. With limited information, they usually send the patient in the right direction while having to fend off some narcissistic clown with a zit on his butt. They absorb the penetrating stares from weary lobby dwellers and channel all that negative energy to some secret place they only tell you about when you go to triage school.

Other kinds of nurses serve key roles in health care and attend to their patients admirably. However, few function under the gun like emergency nurses do.

It is the emergency nurse who cares for the critical heart failure patient until the intensive care unit is "ready" to accept the patient. The productivity of the emergency nurse expands gracefully to accommodate the endless flow of patients while the rest of the hospital "can't take report." Many of our patients arrive "unwashed." It is the emergency nurse who delivers them "washed and folded." To prepare for admission a patient with a hip fracture who lay in stool for a day requires an immense amount of care--and caring.

Few nurses outside of the emergency department deal with patients who are as cantankerous, uncooperative, and violent. These nurses must deal with patients who are in their worst physical and emotional state. We all know it is a stressful time for patients and family, and we all know who the wheelbarrow is that the shovel dumps into.

For the most part, the nurses expect some of this and carry on in good humor. There are times, however, when the patience of a saint is required.
In fact, I believe that when emergency nurses go to heaven, they get in the fast lane, flash their hospital ID, and get the thumbs-up at the gate. They earn this privilege after being sworn at, demeaned, spit on, threatened, and sometimes kicked, choked, grabbed, or slugged. After this, they go on to the next patient as if they had just stopped to smell a gardenia for a moment.

Great strength of character is required for sustained work in our field. The emergency department is a loud, chaotic, and stressful environment. To hold up under these conditions is no small feat. To care for the deathly ill, comfort suffering children, and give solace to those who grieve their dead takes discipline, stamina, and tenderness. To sit with and console the family of a teenager who just died in an accident takes the strength of 10 men.

Every day emergency nurses do what we are all called to do but find so arduous in practice. That is: to love our neighbors as ourselves. They care for those whom society renders invisible. Emergency nurses do what the man who changed the world 2,000 years ago did. They look squarely in the eye and hold the hand of those most couldn't bear to touch. They wash stinky feet, clean excrement, and smell breath that would give most people nightmares.


And they do it with grace.


So, here's to the emergency nurse. Shake the hand of a hero before your next shift.

DR. BAEHREN lives in Ottawa Hills, Ohio, and practices emergency medicine. He is the author of "Roads to Hilton Head Island."

 

[MassEDRN]

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thanks - I'm posting a reply as I get to it... didn't know I wanted to reply until I came upon it... thanks for the info, though, for future reference!

 

[Miami_med]

Ahem: provide a glass of water? Last I checked I was not a glorified nurse's aide.... it is precisely this type of attitude of nursing that sets the profession back - VS are among those listed for CNA's as well, along with foley's, bedpan placements, bed-making...

That's all nice, but it really doesn't explain why you shouldn't get the patient a glass of water. I've always seen the nurse as the caregiver of all of the day to day, hour to hour, needs of the patient. This really can include everything from medication, to fluids, to bedpans, to catheters, to vitals, etc.... I'm not sure where in your training you were taught that nurses were not supposed to get things for their patients, but that mentality is the problem. Since my whole point is that nurses are often passing a good deal of their job off onto others, showing me that others can also do that part of the job doesn't really counteract my point. Your quote was highly political, but nothing in nursing training is really necessary to lift a heavy patient or console a dying patient either. They are simply part of the job. I have no problem with nurses. I like nurses. I usually get along with them. I really do question exactly what it is you are supposed to be doing if the minute by minute care of the patient belongs to the CNA?

 

[Tired]

I've always seen the nurse as the caregiver of all of the day to day, hour to hour, needs of the patient.

It's not just you; their national organizations actively market the nursing profession this way. My own hospital put posters all over that said, "Nursing: The Heart of Medicine".

Or, in the words of our new RN poster, they are the "backbone of medicine".

Too busy caring and supporting to get a glass of water? Interesting.

 

[fab4fan]

It's not just you; their national organizations actively market the nursing profession this way. My own hospital put posters all over that said, "Nursing: The Heart of Medicine".

Or, in the words of our new RN poster, they are the "backbone of medicine".

Too busy caring and supporting to get a glass of water? Interesting.

It's pithy slogans like that that make me want to snatch every administrator bald. Unless they're already bald, in which case I just want to whack them upside the head with an IV pole.

I do what I have to do. I hope I do it well. I used to think the hospital universe revolved around me (i.e. "nursing"). I'm not that naive anymore. We are all important to varying degrees. Could a hospital survive without nurses? I don't know...maybe. It would be tough. It would hard to go without radiology staff, too. Or dietary. You should hear people yell when housekeeping doesn't show up for a couple of hours.

"Nursing: The Heart of Medicine"? That's whack!

 

[ForbiddenComma]

Must I really remind one that nurses are the backbone of the healthcare world...??? Best to change that attitude... you really want nurses as your ally in this healthcare world....

Spam much?

And why do you consider nurse case managers, nurse clinical coordinators and all the rest of that white-coat-crowd with their high-falutin' titles to be "nurses"? They have forever left behind their RN jobs and in fact, many treat real RNs with shocking contempt. It's been years since they've actually served as what the layman considers to be a nurse. They have about as much to do with REAL nursing as the janitor does. Hell, the janitor does more for patient care... at least he keeps the room clean.

And by the way... refusing to get the patient a glass of water when requested? Even I do that, even residents do that. What kind of nurse are you anyway?