When a nurse is your health-care provider, you’re at risk

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going off-label? you naughty!
I was thinking doxylamine.
Calling out @SouthernSurgeon

Depends on the patient and what's going on.

Benadryl is good for the worried well because they don't really need anything.

I generally dislike benzos, but if it's a patient who takes them at home benzo withdrawal has to be considered.

Our psych people have recommended seroquel in several patients and I've had good anecdotal success with that. (off the record psych recommendation for delirium: "They're either on too much seroquel, or not enough")

Ambien is usually pretty well tolerated, but some people get really weird on it and I don't like it in the elderly.

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Oh cool

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"2 of our nurse practitioners went to Yale undergrad and Duke for their Doctorate degree and you don't believe they are qualified..."


Regardless, they may be qualified to understand and do certain things, but IMHO, medically trained and educated physicians should be supervising. There is scope of practice, and there are gray areas in-between that can be missed. This is why it is important to have excellent back-up and supervision. Again, if I were a CRNA, I wouldn't practice independently. CCRNs even straddle somewhat into the line of medicine, with set limitations--to primarily understand and report or even make a medical intervention if certain algorithms are in place. There is some stepping beyond nursing into medicine, especially in the more acute/critical areas. It can't be helped if patients are to have competent and safe monitoring.
So, it's kind of impossible for physicians to be everywhere all the time--and even if you hired enough physicians to replace the nurses, the hospitals would go broke. But that doesn't mean that proper parameters and supervision from physicians shouldn't be firmly in place.

Now if you are someone like this: :)
Dr Whos everywhere at once in anniversary TV special:
TV and Radio


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The eleven doctors of Doctor Who who are part of 50th-year special. In the new mini-episode, Paul McGann, the Eighth Doctor, regenerates into a young John Hurt. Photo: Supplied
 
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I see your point about the supervision. From my experience, which is working with anesthesiology groups and other physician groups to develop policies regarding supervision, it has been explained to me that supervision isn't the word that we should be using anyway, as you stated most of it is on cruise control and nobody needs to be in the room. So although I agree with you on some level, I do believe that we need to stop using the word supervision.

also, nurse practitioners, nurse anesthetist, should not be referred to as nurses. That is part of the problem, all physicians refer to nurses as if they are all the same.the funny thing is that you state that they are not qualified to talk about studies. 2 of our nurse practitioners went to Yale undergrad and Duke for their Doctorate degree and you don't believe they are qualified. Oh yes, I believe that they double majored in biology and nursing. Once again, I am NOT stating the nurse practitioners and nurse anesthetists are more highly educated than physicians. But by stating that they are not qualified to talk about studies, is a very ignorant comment.

with respect to the studies, the American Medical Association did a study 15 years ago which found that the quality of care and the outcomes were equivalent between nurse practitioners and physicians. I agree with you that we should always be looking at studies to see who is funding them and how they were analyzed, however many of these studies have been done across the board with both nurses and physicians working hand-in-hand to analyze the issue. You might want to read the Institute of Medicine's report on it which was co-authored by a physician.once again, although I agree with you on some level, your conclusion that oldies studies are fun did eminem related to buy your sis is large sweet basil us.once again. although I agree with you on some level that we should be skeptical of any type of study, your conclusion that nurses have funded and manipulated these studies is largely baseless. Feel free to post an analysis that 40 years of research has been manipulated by the nursing establishment. I believe it would be an interesting read.


One can double major in biology and nursing? I learn something new everyday.
 
One can double major in biology and nursing? I learn something new everyday.

If while taking clinical prereqs during the biology portion and delaying graduation, I guess it's possible.

At my undergraduate university, the nursing biology prereqs were part of an applied biology program where the chemistry, micro, general bio, and anatomy were watered-down and it didn't require biochem.

The "real" biology degree courses that I had transferred over to nursing, but had I wanted to do nursing then biology, it wouldn't have transferred the other way.

I feel like, either way, it's more of a post-bach situation rather than a double-major because, when in nursing clinical, you're exclusively taking clinical courses at pretty much all of the programs I've seen (anecdotal, I know).
 
I see your point about the supervision. From my experience, which is working with anesthesiology groups and other physician groups to develop policies regarding supervision, it has been explained to me that supervision isn't the word that we should be using anyway, as you stated most of it is on cruise control and nobody needs to be in the room. So although I agree with you on some level, I do believe that we need to stop using the word supervision.

also, nurse practitioners, nurse anesthetist, should not be referred to as nurses. That is part of the problem, all physicians refer to nurses as if they are all the same.the funny thing is that you state that they are not qualified to talk about studies. 2 of our nurse practitioners went to Yale undergrad and Duke for their Doctorate degree and you don't believe they are qualified. Oh yes, I believe that they double majored in biology and nursing. Once again, I am NOT stating the nurse practitioners and nurse anesthetists are more highly educated than physicians. But by stating that they are not qualified to talk about studies, is a very ignorant comment.

with respect to the studies, the American Medical Association did a study 15 years ago which found that the quality of care and the outcomes were equivalent between nurse practitioners and physicians. I agree with you that we should always be looking at studies to see who is funding them and how they were analyzed, however many of these studies have been done across the board with both nurses and physicians working hand-in-hand to analyze the issue. You might want to read the Institute of Medicine's report on it which was co-authored by a physician.once again, although I agree with you on some level, your conclusion that oldies studies are fun did eminem related to buy your sis is large sweet basil us.once again. although I agree with you on some level that we should be skeptical of any type of study, your conclusion that nurses have funded and manipulated these studies is largely baseless. Feel free to post an analysis that 40 years of research has been manipulated by the nursing establishment. I believe it would be an interesting read.

Yale does not offer undergraduate nursing (BSN or otherwise). Either you're lying or they are.
 
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Yea, I think the poster meant to say the graduate school:
http://nursing.yale.edu/academics

LOL. Yale is too good to have an undergrad nursing program. :)

If a person is going to list "impressive" credentials to affirm someone else's abilities to research and interpret research, that person should probably get the credentials right.
 
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From my understanding (correct me if I'm wrong), malpractice insurance for NPs is wayyy lower than for physicians---why is this? I would suspect that with this new influx of newbies that it would just be a matter of time before malpractice lawyers jump all over them.
 
I also don't see how degrees from prestigious Universities in and of themselves makes someone qualified for clinical medicine, er "advanced nursing".
 
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I also don't see how degrees from prestigious Universities in and of themselves makes someone qualified for clinical medicine, er "advanced nursing".

I got accepted into Yale dental school so I am gonna be a great dentist!

Oh wait...
 
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Here is your Cochrane study: http://dhhs.ne.gov/publichealth/licensure/documents/SubOfDrsByNursesInPrimaryCare.pdf

"The findings suggest that appropriately trained nurse can produce as high quality care as primary care doctors and achieve as good health outcomes for patients."
"The findings suggest that nurses and doctors genereate similar health outcomes for patients, at least in the short-term, over the range of care investigated... The findings must be viewed with caution, however, given that only 1 study (in which nurses provided first contact care for patients wanting urgent attention out-of-hours) was powered to assess equivalence of care."

I lol'd because it reinforced everything that I knew about nursing propaganda and academic studies. Using non-conclusive studies to justify propaganda platform? Check. Misrepresenting studies so that you can say that they reached your personal conclusions? Double check.
 
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"The findings suggest that nurses and doctors genereate similar health outcomes for patients, at least in the short-term, over the range of care investigated... The findings must be viewed with caution, however, given that only 1 study (in which nurses provided first contact care for patients wanting urgent attention out-of-hours) was powered to assess equivalence of care."

I lol'd because it reinforced everything that I knew about nursing propaganda and academic studies. Using non-conclusive studies to justify propaganda platform? Check. Misrepresenting studies so that you can say that they reached your personal conclusions? Double check.

Why is it that almost always, without fail, when someone posts a study to back up their position, they haven't actually read the damn study? It's as if by merely saying "here's a study that proves X", it's sufficient to prove X. Mind boggling.
 
Why is it that almost always, without fail, when someone posts a study to back up their position, they haven't actually read the damn study? It's as if by merely saying "here's a study that proves X", it's sufficient to prove X. Mind boggling.
When you're in high school/college and you're trying to prove someone wrong, you go to Google and type in whatever your viewpoint is and click on the first hit.

When you're in med school/post-graduate education and you're trying to prove someone wrong, you go to PubMed and type in whatever your viewpoint is and click on the first hit.
 
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You're not being condescending at all. There is a pervasive cultural undermining of expertise and hierarchy in the general public which nursing dogma has harnessed and maximized for its own objectives.

For medical students if you have one thought in your head that you'll fix all this as an intern, you pull your car over right now, hold a gun to its head and tell it to get the F out.

Instead you utilize their mindset and direct it at decisions of no clinical consequence. Gee whiz, I'd hate to have to do an enema...what do you like to use for your constipated patients? And so on.

Also, the wider cultural impulse often goes belly up in the practical world. Most nurses want you to be The Doctor when a family is pestering them to speak to one. Or when the **** is hitting the fan or for whatever other reasons.

Also there's a lot of foreign born nurses that work harder and respect hierarchy that serve to rudder against the tide of Bolshevism.

This is also in response to the post about the tele floor from@GuyWhoDoesStuff as well.

So I am a nurse and have worked on several floors, general medical and surgical floors as well as ICU's. I am now going to start medical school. I wasn't going to respond to this thread as I think that many on here have the right idea and have found this blog interesting. Nurse practitioners overstepping their bounds is dangerous ... Which is why I am going the medical school route. I start in the fall.

In response to the comment about the tele nurses. I bet if you had taken the time to explain to the nurses why you didn't want to push fluids, they would have understood what you were doing, respected and trusted you more, and gone on to provide better care to your patients. The time doctors have taken to teach me has helped me understand why my thinking was wrong or flawed and has been a huge part of helping me take better care of my patients.

We (Nurses) are cautious of trusting an intern's orders because we have probably been burned in the past (I know I have). If you explain your reasons for treatments to start, we will understand you know what you are talking about. The next time we are more likely to go with the flow; we understand you aren't making decisions from nowhere (Which happens a lot more often with interns than you would think).

Nasrudin -- I have worked with amazing, amazing physicians that built a team environment, provided excellent care, took the leadership role, and helped improve everyone around them. I have also worked with those who did not. Respecting a physician for their knowledge is important, being condescending to nurses is not.
 
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hmmm...when it's a floor nurse interacting with a resident/clerk, it's the floor nurse that actually holds more power and the 'home turf advantage' in the dynamic. i hear the logic of wanting to know the rationale behind an approach. also, that the nurse and learner could both learn from a supportive discussion. they style of the hospital does not typically favour such supportive discussions. unfortunately, there is also a lot of bullying encouraged of anyone 'lower' in the heirarchy - i.e. of learners from nurses. this does lead to craziness at times. it really is up to the folks in power to look at how they are continuing to bully, etc. because that bullying does lead to poor outcomes. what learner would want to talk about their rationale for fluids at a nursing desk that has people already engaged in bullying behaviours? that's not an environment that supports sharing rationale for a plan. and it is all too common.

in re-reading what nazrudin wrote, and the post by gomersgotoground that they were responding to, i'm not sure i saw a lot of condescension. but there was frustration with poor communication between nurses and learners, supported by the culture of the hospital, and encouraged by messages received in training (although m.d. training these days is a lot about interprofessional respect, and the critique here was that out of nursing was coming messages that seem to undermine that, and suggest antagonism as an important part of a nurse's stance in the name of patient safety).

of course, that polarity of interprofessional vs 'save the patients from doctors' can be deconstructed too as being less polarized than that, and both sides having both messages, likely. md has hidden curriculum that persists around devaluing nurses/supporting heirarchical absolute decisions (i.e. acknowledging when thrust into 'you're the boss' when there's a difficult family to deal with, or a law suit), and nursing has messages that would support interprofessionalism, and that this is all playing out where there is a lot of contestation of professional boundaries supported and started by those who benefit from altering systems of payment...so i would differ with nasrudin who says that lefty commo-pinky ideology in nursing models is to blame, and say that capitalistic models of labour and reimbursement are just as equally to blame, and likely the people who benefit from capitalistic models of labour and undercutting price are actually co-opting those pinky ideologies to serve for capitalistic purposes. just like big oil and gas (capitalism at its finest) that co-opt 'mother earth' messaging (lefty commo-pinky aboriginal hippy etc etc at its finest) in these ridiculous looking ads they put out at times. or dove ads co-opt feminist discourses around critiquing standards of 'beauty' in their campaign around beauty in all shapes and sizes, in order to profit by selling beauty products. co-optation of the left is not a new idea, but has been very effective.

so let's not ignore or brush aside the bullying that can go on from nurses to learners too quickly. and the system that supports it.
 
hmmm...when it's a floor nurse interacting with a resident/clerk, it's the floor nurse that actually holds more power and the 'home turf advantage' in the dynamic. i hear the logic of wanting to know the rationale behind an approach. also, that the nurse and learner could both learn from a supportive discussion. they style of the hospital does not typically favour such supportive discussions. unfortunately, there is also a lot of bullying encouraged of anyone 'lower' in the heirarchy - i.e. of learners from nurses. this does lead to craziness at times. it really is up to the folks in power to look at how they are continuing to bully, etc. because that bullying does lead to poor outcomes. what learner would want to talk about their rationale for fluids at a nursing desk that has people already engaged in bullying behaviours? that's not an environment that supports sharing rationale for a plan. and it is all too common.

in re-reading what nazrudin wrote, and the post by gomersgotoground that they were responding to, i'm not sure i saw a lot of condescension. but there was frustration with poor communication between nurses and learners, supported by the culture of the hospital, and encouraged by messages received in training (although m.d. training these days is a lot about interprofessional respect, and the critique here was that out of nursing was coming messages that seem to undermine that, and suggest antagonism as an important part of a nurse's stance in the name of patient safety).

of course, that polarity of interprofessional vs 'save the patients from doctors' can be deconstructed too as being less polarized than that, and both sides having both messages, likely. md has hidden curriculum that persists around devaluing nurses/supporting heirarchical absolute decisions (i.e. acknowledging when thrust into 'you're the boss' when there's a difficult family to deal with, or a law suit), and nursing has messages that would support interprofessionalism, and that this is all playing out where there is a lot of contestation of professional boundaries supported and started by those who benefit from altering systems of payment...so i would differ with nasrudin who says that lefty commo-pinky ideology in nursing models is to blame, and say that capitalistic models of labour and reimbursement are just as equally to blame, and likely the people who benefit from capitalistic models of labour and undercutting price are actually co-opting those pinky ideologies to serve for capitalistic purposes. just like big oil and gas (capitalism at its finest) that co-opt 'mother earth' messaging (lefty commo-pinky aboriginal hippy etc etc at its finest) in these ridiculous looking ads they put out at times. or dove ads co-opt feminist discourses around critiquing standards of 'beauty' in their campaign around beauty in all shapes and sizes, in order to profit by selling beauty products. co-optation of the left is not a new idea, but has been very effective.

so let's not ignore or brush aside the bullying that can go on from nurses to learners too quickly. and the system that supports it.

I see where you are coming from and agree nurses making an interns life miserable, questioning everything, and bullying then shouldn't be sweeped aside and can be dangerous.

I was getting condescending attitude from @Nasrudin when he capitalized The Doctor when a family wants to talk to the doctor, the comment that foreign born nurses are the rudder that helps to prevent disrespect, and when he was "distracting" nurses with a side comment about a completely different problem, likely to get them to stop bugging him about a different problem.

Maybe I misread some of his quotes as being sarcastic but his post to me seemed to be reading that the nurses were annoying him when they sought him out when stuff was going bad or when the family wants to talk to the doctor.
 
This thread is about mid level nurse practitioners, not about your personal agenda concerning a perceived slight against nurses
 
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I see where you are coming from and agree nurses making an interns life miserable, questioning everything, and bullying then shouldn't be sweeped aside and can be dangerous.

I was getting condescending attitude from @Nasrudin when he capitalized The Doctor when a family wants to talk to the doctor, the comment that foreign born nurses are the rudder that helps to prevent disrespect, and when he was "distracting" nurses with a side comment about a completely different problem, likely to get them to stop bugging him about a different problem.

Maybe I misread some of his quotes as being sarcastic but his post to me seemed to be reading that the nurses were annoying him when they sought him out when stuff was going bad or when the family wants to talk to the doctor.

The technique was misunderstood and I take blame for that. I mean you become known as a physician who respects nursing input when it comes to getting whatever they want that doesn't have potential adverse consequences--like method of Bowel regimentation. But when it comes to something that does you explain your reasoning and hold your ground against pressure to do something stupid.

But your offense serves my cultural point. You're training in the Kung Fu of Being Offended serves you well. But just be assured, as someone who hasn't taken a single night of call as a physician, your opinion is of no consequence to me . I am here to help my colleagues get across hostile territory as they enter their intern year in one piece without injuring a patient.

My more interpretive cultural descriptions are for my own amusement but also to depersonalize the interactions of an intern and a nurse that could potentially be oppositional by placing it in a broader context.

--Nasrusin, MD. 1/22/2015, 1845

^^^^notice the documentation 4 th years. I explain my reasoning and dropped a note. If the nurse decides to raise a fuss with his/her supervisors. A note like this will make him/her look like a proper lunatic. You stay cool, logical, friendly, and you document it. You should also be careful, smart, cautious, and deft in diversionary tactics--and forget what the PC protocol engineers think is legit. Subtle flirtation, is perfectly reasonable. Were it not I would have had a harder time like some of my female colleagues. You don't find this in your handbook. Which is why I post it here.
 
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the froggie seems to know the hostile...erm...hospital politics he is talking about.

640px-M11_piggy_ninja.jpg
 
the froggie seems to know the hostile...erm...hospital politics he is talking about.

View attachment 188790

Haha. On the subject of animal behavior and as it pertains to the wider politics:

I think a useful metaphor could be to think of nursing as a predatory pack animal. Wolves, hyenas, something like this. And that physicians are larger, but solitary animals. A solitary bull elephant or a bear or something. We are vulnerable to pack predation when we are interns/infants. And it's important to have the instincts that reflect that reality.

Also as it pertains to the body politic. I believes it's this lack of pack groupthink that makes us politically inept and also how they easily undergo group hypnotic synergy when hunting prey like socially unsophisticated interns or politically NP independent practice rights.
 
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hmmm...when it's a floor nurse interacting with a resident/clerk, it's the floor nurse that actually holds more power and the 'home turf advantage' in the dynamic. i hear the logic of wanting to know the rationale behind an approach. also, that the nurse and learner could both learn from a supportive discussion. they style of the hospital does not typically favour such supportive discussions. unfortunately, there is also a lot of bullying encouraged of anyone 'lower' in the heirarchy - i.e. of learners from nurses. this does lead to craziness at times. it really is up to the folks in power to look at how they are continuing to bully, etc. because that bullying does lead to poor outcomes. what learner would want to talk about their rationale for fluids at a nursing desk that has people already engaged in bullying behaviours? that's not an environment that supports sharing rationale for a plan. and it is all too common.

in re-reading what nazrudin wrote, and the post by gomersgotoground that they were responding to, i'm not sure i saw a lot of condescension. but there was frustration with poor communication between nurses and learners, supported by the culture of the hospital, and encouraged by messages received in training (although m.d. training these days is a lot about interprofessional respect, and the critique here was that out of nursing was coming messages that seem to undermine that, and suggest antagonism as an important part of a nurse's stance in the name of patient safety).

of course, that polarity of interprofessional vs 'save the patients from doctors' can be deconstructed too as being less polarized than that, and both sides having both messages, likely. md has hidden curriculum that persists around devaluing nurses/supporting heirarchical absolute decisions (i.e. acknowledging when thrust into 'you're the boss' when there's a difficult family to deal with, or a law suit), and nursing has messages that would support interprofessionalism, and that this is all playing out where there is a lot of contestation of professional boundaries supported and started by those who benefit from altering systems of payment...so i would differ with nasrudin who says that lefty commo-pinky ideology in nursing models is to blame, and say that capitalistic models of labour and reimbursement are just as equally to blame, and likely the people who benefit from capitalistic models of labour and undercutting price are actually co-opting those pinky ideologies to serve for capitalistic purposes. just like big oil and gas (capitalism at its finest) that co-opt 'mother earth' messaging (lefty commo-pinky aboriginal hippy etc etc at its finest) in these ridiculous looking ads they put out at times. or dove ads co-opt feminist discourses around critiquing standards of 'beauty' in their campaign around beauty in all shapes and sizes, in order to profit by selling beauty products. co-optation of the left is not a new idea, but has been very effective.

so let's not ignore or brush aside the bullying that can go on from nurses to learners too quickly. and the system that supports it.

Sorry, but taking a minute to respond to oldanddone. I see your points. I do not disagree that there can be a lot of bullying in nursing. I do, however, have to agree with Nas, that in reality, at least as far as I have seen over the years and through education, well, there often is a lot of left-leaning political sway in nursing from the top down. And the political support from the ANA and such in the last decade or so supports this. I mean, some of it seems useful, and other parts, well, not so much. Beyond that, I do see the use of leftist politics as a means to advance the political-professional agendas in nursing. I am not trying to disrespect my own at all. I have worked with and sat under some awesome nurse professionals and professors. But I think some of these people at the top need to realize they have just gone overboard. There is already so much division and fragmentation is healthcare. Truth is, we don't need the extra burden it has placed on everyone. It's really kind of simple. If one wants to work as a leader in medicine, he or she needs to go to medical school. I don't see why we should shorten the standards.
 
But I am going to also say this, which is sort of unrelated to the previous comment. No Nas. If there is logic and reasoning that works for the benefit of the patient, don't be stuck to stand your ground. You are doing everyone, including the patient, a great disservice if, God forbid, you or any other resident or doc does this.

It's simple. Take the BS pride out of the equation, period. Most nurses don't want to go the way of some pizzing contest. I am there to keep the patient safe, end of story.

I remember one anesthesiology-fellow who decided not to listen to me about a cardiac babe scheduled for surgery. Really he would have, but b/c of a kind of bullying that oldandone described, the charge nurse that night decided to get involved and influenced the anesth-fellow in a tug of war--with him listening to her. It was a bad choice on his part. When the attending anesthesiologist came in to take the patient in the morning, that anesthesiologist reamed his azz out for not listening to me when taking the kid to surgery.

Now if the anesth-fellow had put aside all the BS--including the inside political BS from the goofy, young, 'I've-got-something-to-prove' charge nurse, who was letting her turn at that role get to her ahead (lol what a mess), and IF he had put the best interest of the patient before anything else--and used his brains, he wouldn't have gotten his azz chewed out. I actually felt badly for him as he scurried along trying to kiss the attending anesthesiologist's azz for forgiveness whilst heading to the OR.

Whenever people let pride or anything less than putting the patient first guide their practice, they are falling WAY short of the mark. I wish that was the only time I have seen this kind of thing. But I could tell sad and horrible stories of suffering and needless deaths that have resulted from this kind of pride or BS.

Sorry. At the end of the day, I have to sleep, knowing I did my best to put the patient first. A lot of nurses and doctors, thank God, are like that. Too bad there remains some number of them that don't. Pride-based poor actions are just as bad as incompetent ones. Sometimes, they are a hell of a lot worse.
 
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Whenever people let pride or anything less than putting the patient first guide their practice, they are falling WAY short of the mark.
Interesting. So would you say that when mid-level providers let pride or anything less than putting the patient first guide their practice (i.e. positing that they have the experience/depth of knowledge of a physician for obvious reasons of prestige, ego-stroking, and income) that they too are falling WAY short of the mark?
 
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Interesting. So would you say that when mid-level providers let pride or anything less than putting the patient first guide their practice (i.e. positing that they have the experience/depth of knowledge of a physician for obvious reasons of prestige, ego-stroking, and income) that they too are falling WAY short of the mark?


In a word, YES.
 
so no pride-based decisions. ok.
or fear-based decisions...don't get intimidated by those who would try to on the wards. keep thinking.
or trusting decisions....don't trust those who would ask for your trust, or demand your trust. keep thinking. unless they are your direct superior who gives you the feedback that advances or holds you back.

i agree that there are lots of lefty politics that have advanced the whole nursing thing. however, i believe that these politics are being listened to/ given power only because it is advancing a righty kind of agenda - to cut costs and undermine autonomy, to make independent professionals into 'cheapest labour units'.

in terms of animaux:

the parties benefiting from lefty politics being used to support righty agendas would be the carrion folks, feeding off of the work of others, those who bring home the profits, likely without much clinical work at all under their belts: these would be vultures in the roles of administrators, third party business owners, etc.

vultures chuckling while supporting the lefty hyena packs take down the elephants and wolves, knowing that the vultures themselves will feed well.
 
..and i feel sorry for the fellow who got caught in the middle of some terrible politics. his kung fu was not strong enough. he was taken down.
 
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..and i feel sorry for the fellow who got caught in the middle of some terrible politics. his kung fu was not strong enough. he was taken down.


That's what buddy-politics over doing the right thing will do for you. Later on the fellow moved up. He was well-liked and working the whole buddy-politics deal. Not too far after, he was named in a pretty severe lawsuit, which the hospital ended up settling out of court for many millions.

A person has to have the integrity to do the right thing over buddy politics or other stupidity. It's a shame really.
 
This is also in response to the post about the tele floor from@GuyWhoDoesStuff as well.

So I am a nurse and have worked on several floors, general medical and surgical floors as well as ICU's. I am now going to start medical school. I wasn't going to respond to this thread as I think that many on here have the right idea and have found this blog interesting. Nurse practitioners overstepping their bounds is dangerous ... Which is why I am going the medical school route. I start in the fall.

In response to the comment about the tele nurses. I bet if you had taken the time to explain to the nurses why you didn't want to push fluids, they would have understood what you were doing, respected and trusted you more, and gone on to provide better care to your patients. The time doctors have taken to teach me has helped me understand why my thinking was wrong or flawed and has been a huge part of helping me take better care of my patients.

We (Nurses) are cautious of trusting an intern's orders because we have probably been burned in the past (I know I have). If you explain your reasons for treatments to start, we will understand you know what you are talking about. The next time we are more likely to go with the flow; we understand you aren't making decisions from nowhere (Which happens a lot more often with interns than you would think).

Nasrudin -- I have worked with amazing, amazing physicians that built a team environment, provided excellent care, took the leadership role, and helped improve everyone around them. I have also worked with those who did not. Respecting a physician for their knowledge is important, being condescending to nurses is not.

You may pleased to know that I actually did explain my reasoning in a very simple, direct, and kind way. In fact, I was the one who explained it to them after the attending reamed them out. They had been talking behind my back while I was busy putting orders in, and they got to the attending before I could talk to them. The attending never explained the reasoning when he talked to them. I did notice that they began to respect me quite a bit more after that. I don't mean to toot my own horn, but the tele/ICU nurses (they share a somewhat common nursing pool) voted me "least incompetent intern" in June, a running gag they've apparently had going for a few years now.

One of them also tried to get me to go out on a date with her multiple times, despite me making it clear that my wife would probably not be on board.
 
I think it's hilarious how the nursing lobbyists try to say that NPs have the golden touch to patient care. If I would ever talk to a patient like my wife was talked to by a NP at a convenient care, my faculty member would have ripped me up.
 
You may pleased to know that I actually did explain my reasoning in a very simple, direct, and kind way. In fact, I was the one who explained it to them after the attending reamed them out. They had been talking behind my back while I was busy putting orders in, and they got to the attending before I could talk to them. The attending never explained the reasoning when he talked to them. I did notice that they began to respect me quite a bit more after that. I don't mean to toot my own horn, but the tele/ICU nurses (they share a somewhat common nursing pool) voted me "least incompetent intern" in June, a running gag they've apparently had going for a few years now.

One of them also tried to get me to go out on a date with her multiple times, despite me making it clear that my wife would probably not be on board.

I think your wife needs to know what's just business and what's actually extracurricular. Entre nous, I share your style of conducting business. In that being sexy is my business.

Sexiness plus sweetness = competence in more minds than is politically correct to corroborate. Yet true it is nonetheless. I was a flat f'n mediocre medicine intern that was considered "good" by nurses.

Who, if it wasn't inferentially obvious, don't know what is a clinically sophisticated intern when they see it. Because what they do is not what we do. Although sometimes they think they do. Or often do.

As per the whole I'm not practicing medicine I'm practicing nursing, but really I'm practicing medicine mindf@ckery that can only arise from delusion run amuck.
 
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I think your wife needs to know what's just business and what's actually extracurricular. Entre nous, I share your style of conducting business. In that being sexy is my business.

Sexiness plus sweetness = competence in more minds than is politically correct to corroborate. Yet true it is nonetheless. I was a flat f'n mediocre medicine intern that was considered "good" by nurses.

Who, if it wasn't inferentially obvious, don't know what is a clinically sophisticated intern when they see it. Because what the do is not what we do. Although sometimes they think they do. Or often do.

As per the whole I'm not practicing medicine I'm practicing nursing, but really I'm medicine mindf@ckery that can only arise from delusion run amuck.


I like you.
 
I think your wife needs to know what's just business and what's actually extracurricular. Entre nous, I share your style of conducting business. In that being sexy is my business.

Sexiness plus sweetness = competence in more minds than is politically correct to corroborate. Yet true it is nonetheless. I was a flat f'n mediocre medicine intern that was considered "good" by nurses.

Who, if it wasn't inferentially obvious, don't know what is a clinically sophisticated intern when they see it. Because what they do is not what we do. Although sometimes they think they do. Or often do.

As per the whole I'm not practicing medicine I'm practicing nursing, but really I'm practicing medicine mindf@ckery that can only arise from delusion run amuck.

Someone should name a drink after this.

"I'll take a medicine mindf@ckery. Neat."

Don't want to dilute it, because it's got a sweet burn.
 
Nice try. Not biting "sexy plus sweetness." ;)
 
I saw a electronic billboard driving home last night with a picture of a NP. The caption say "Nurse Practitioners... We Listen." It was advertising for some organization, but the billboard switched too quick for me to notice. What other medical field has their own ad campaign?
 
I saw a electronic billboard driving home last night with a picture of a NP. The caption say "Nurse Practitioners... We Listen." It was advertising for some organization, but the billboard switched too quick for me to notice. What other medical field has their own ad campaign?

Physicians need to have one---highlighting that we have 100x more clinical hour exposure during training and that the NPs could practically never pass our board exams. Wish the AMA would start asking me about that in emails instead of worrying about expanding residency slots all the time.

Of course, the main thing that docs need to do is just explain to their family and friends the differences....if the several hundred thousand physicians explained it to family and friends, we could probably change the perception of several million people overnight
 
I saw a electronic billboard driving home last night with a picture of a NP. The caption say "Nurse Practitioners... We Listen." It was advertising for some organization, but the billboard switched too quick for me to notice. What other medical field has their own ad campaign?
The subliminal message is so transparent here: 'Doctors don't listen.'
 
I think it's hilarious how the nursing lobbyists try to say that NPs have the golden touch to patient care. If I would ever talk to a patient like my wife was talked to by a NP at a convenient care, my faculty member would have ripped me up.

This is the thing that always baffles me too, there is this idea that nurses are the more compassionate/caring of the healthcare profession, but I just don't see it.

In clinics its always a nurse wanting to turn away the patients who are x minutes late and the doc is always like "I'm just as frustrated as you, but we should take care is them" then the nurses are ticked off that their lunch break is only 50 minutes. Or they are huffing at you because you want a bp recheck on someone who came in at 160/100.

Seems like nurses also are way more likely just to be like "O Ive known this patient from prior visits/hospitalizations and they are full of ****" and completely blow them off. While the culture of medicine is more to provide the standard of care no matter how you feel about the patient.

Or nurses love protocols when they are convenient for decreasing work, but not when they cause more work. I always laughed when I would see the stone cold normal nursing domestic violence screenings in the EMR on patients with a chief complaint of "my husband punched me".


Don't get me wrong, when a nurse feels a connection w/ a patient they will go to lengths no doctor likely would, but god help the patient who a nurse feels is below them for whatever reason. Physicians seem to be a lot more even keeled in this regard
 
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i just read an article on medicine and two competing discursive regimes - the competence regime and the caring regime.

typically in medical education and in the everyday the competence regime takes centre stage (like with the tolerance for a great doc with poor bedside manner, and a distrust of great bedside manner possibly meaning not so much competence). in terms of nursing and medicine, i have a feeling that at one point this was gender-divided labour - the women/nurses were caring and the men/doctors were competent, and these two separate spheres were to work symbiotically as a patient's almost mother/father duo.

these days, medicine is attempting to strengthen the caring regime (cultural competency, patient-centred medicine concepts in primary care). nursing is attempting to strengthen the competence regime. however, when it comes to advertising, it makes sense that nps can still rely on the strong brand of nurse=caring. doctors could likely still rely on the brand of doctor = competent. Doctors= We Know How To Cure You. that would be very sellable, as it fits in with the old doctor discourse.

often in these threads the competency regime is the main defense for doctors given - more education, more competent, therefore the creep shouldn't happen. the examples of how doctors are caring are important as well in today's discursive reality where the competency/caring divide between disciplines is not a given - making room for the late patient, not being swayed by a difficult patient to do less of a workup etc., are those caring examples.
 
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i just read an article on medicine and two competing discursive regimes - the competence regime and the caring regime.

typically in medical education and in the everyday the competence regime takes centre stage (like with the tolerance for a great doc with poor bedside manner, and a distrust of great bedside manner possibly meaning not so much competence). in terms of nursing and medicine, i have a feeling that at one point this was gender-divided labour - the women/nurses were caring and the men/doctors were competent, and these two separate spheres were to work symbiotically as a patient's almost mother/father duo.

these days, medicine is attempting to strengthen the caring regime (cultural competency, patient-centred medicine concepts in primary care). nursing is attempting to strengthen the competence regime. however, when it comes to advertising, it makes sense that nps can still rely on the strong brand of nurse=caring. doctors could likely still rely on the brand of doctor = competent. Doctors= We Know How To Cure You. that would be very sellable, as it fits in with the old doctor discourse.

often in these threads the competency regime is the main defense for doctors given - more education, more competent, therefore the creep shouldn't happen. the examples of how doctors are caring are important as well in today's discursive reality where the competency/caring divide between disciplines is not a given - making room for the late patient, not being swayed by a difficult patient to do less of a workup etc., are those caring examples.


Even in my first semester of medical education I was provided MANY opportunities to work on empathy and caring with a SP and to receive feedback on how my actions and personality were perceived by others. Most medical schools do just as good of a job teaching "caring" as nursing schools do, and yes, the doctors need to preach this to the public. Also, FMGs and IMGs are becoming less and less--so there's much less of a cultural/language barrier between physicians and patients.

The public needs to be confident that physicians actually are taught to care, but even more so that we won't kill you because we have 100x more clinical education
 
I wonder how long until NPs become the low hanging fruit for malpractice lawyers? I would assume that in a court, that a NP practicing in a state that allows full practice with autonomy should be judged on the same criteria as a board certified physician in that specialty. How long until the malpractice lawyers realize it would be SO easy to blame something that went wrong on a NP who took a bunch of online classes and think that they're qualified to work in an ED? Yes, they will defer some of these to the EM physician, but as the numbers of NPs keep increasing, I bet you'll see more of them trying to manage these cases themselves
 
I truly can't fathom how generalization about people either way will make a difference.
There are compassionate nurses and compassionate docs, and there are those that really don't have a lot of compassion, understanding, insight, and listening abilities--both docs and nurses--and then there are a lot of people that fall in-between these two poles.

I mean the midlevel practice issue, at it's core, is about cutting costs and saving money. At the same time, schools everywhere are just psyched about all that they can make off of such problems. And if anyone really cared about real quality of turn-out--not mere dollars for schools or pushing an agenda, they would not be allowing nurses with very minimal experience entrance into advanced practice nursing programs.

But again, individuals are who they are regardless of if they go through MS programs or nursing programs. If anything, the crucible of each kind of program and practice will ultimately strengthen their underlying character or the programs and real life healthcare experiences will reveal their true characters.

I think one area in which we see where patients care not only about competence in practice but compassion is in the OBGYN field. Some women are hell-bent on having only female physicians--feeling they will be more compassionate, understanding, and it will be less embarrassing for them. But this is not necessarily true. Now, I am not saying there are not truly compassionate female OBGYNs. It's just for me, at least in my area, well, it's usually male OBGYNs that have been more compassionate, tender and not painful upon examination, and more active listeners, etc. And believe me, there have been a few male OBGYNs that I refused to see, b/c they were hurtful upon examination, and they didn't listen, and they just didn't have that sensitive nature women look for in an OBGYN. But remember, in my area at the time, 99% of the OBGYNs were male. So, the compassionate female OBGYNs with the tender touch and ability to actively listen and be sensitive, well, I never got a chance to meet them.

You just can't generalize. I look for certain characteristics regardless of gender, age, race, whatever. It's wrong to generalize. And I would add that it's also unfair to lead a campaign that implies one group of providers are "listeners," so the inference is that the other providers are not. That's really on the manipulative side.

Also, nursing is running off an older model where holistics in medicine were laughed at in education and practice, in general, and where the main focus was on the pathology and not the human being as a whole person--an individual, and there was a sense of distance from this approach. But medical education has improved to look more at the whole person. But the campaign is running off of older models and exploiting this. Actually, the psyh0-social dynamics of this is interesting.

But the other thing that must be considered is that in the educational process for nursing, a strong amount of emphasis is placed on active listening, compassion, avoiding judgment, and holistics. It's there in every course from fundamentals and onward. Now, some of this will just wash over some people, but the points are emphasized repeatedly in these programs. In medical school, there is so much focus on the science and such, that the position of the nursing profession is that holistic approach, active listening, etc is lost. In other words, it would tend to get lost in the great magnitude of material or in is not embedded deeply enough through each and every course in medical education. Again, I think MS programs have worked to try and change this. But the model in nursing begins and ends with the whole human being--not just pathologies. Hence to them, the use of the declarative, "We listen," is not necessarily manipulative. Perhaps nursing needs more education about the MS educational process and their programs. IDK.

Whatever, just sharing from the position I have seen. Regardless, generalizations suck.
 
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