If nurses want to be doctors, who's going to be the nurse?

[fang]

Seems like many threads get into debates about the differences between MD's and nurses, PA's, etc, and every aspect of their respective roles.

My observation is that everyone seems to want to be the doctor--
1. Nurses with PhDs and some PA's want to call themseves "Doctor whatever"
2. Everyone wants to wear the white coat
3. There is a turf war going on about who can prescribe what in which state

If everyone wants to be a doctor and keeps struggling so desparately to take over doctors' roles, who is going to be the nurse?? If I were in the hospital, I'd rather have a great nurse and a competent doctor than the other way around, assuming I didn't have something unusual or hard to manage. Good nurses are there for their patients no matter what kind of smelly, embarassing, or offensive thing is going on-- someone needs to be nearby, in case they suddenly need CPR, need to vomit, need an IV, or just need to talk. The new trend seems to be to jettison all of that in search of more power, prestige, and self-importance -- they think that mimicing doctors' roles will bring all that. If I'm ever sick and need some help, God forbid I get some nurse who wants to listen to my heart all the time and make suggestions about BP meds.

We need to encourage people who want to prescribe medication and act as independant practitioners to go to medical school, and be clear about what practicing medicine and practicing nursing means-- they should not be synonymous... real nurses are too important.

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[NonTradMed]

From what I understand after reading some postings at nursing forums, many nurses believe they are better at providing care to patients than doctors, and that allowing for more autonomy will enable them to carry that higher quality of care to the next level---i.e practitioner level.

I'm not a nurse, have met few nurses in my lifetime, so this is just what I gathered from all the stuff I've read on nursing. This forum is biased for doctors (and nurses who want to attend med school), so I don't think we'll get a true debate on this issue.

 

[QuikClot]

I work with nurses all the time. Very few of them want to be doctors. Lots of them want to work less and make more . . . but I have never seen anyone express envy of the doctors.

(I hope) I don't understand what you mean by "who's going to be the nurse?" It seems like you are saying "Who's going to be subordinate to the doctor and carry out menial functions?" but that is not really what RNs do, nor has this been their role for some time.

There are CNAs, monitor techs, ED techs, etc. to act as support staff. It seems to me your question is like asking "If everyone wants to be a partner at the law firm, who's going to be the associates/paralegals/secretaries?" And the answer is the same as it has always been; people who can't get the most respected and well-paid positions fill the ranks of the less priviledged ones. The reason is called "rent."

 

[fab4fan]

I work with nurses all the time. Very few of them want to be doctors. Lots of them want to work less and make more . . . but I have never seen anyone express envy of the doctors.

(I hope) I don't understand what you mean by "who's going to be the nurse?" It seems like you are saying "Who's going to be subordinate to the doctor and carry out menial functions?" but that is not really what RNs do, nor has this been their role for some time.

There are CNAs, monitor techs, ED techs, etc. to act as support staff. It seems to me your question is like asking "If everyone wants to be a partner at the law firm, who's going to be the associates/paralegals/secretaries?" And the answer is the same as it has always been; people who can't get the most respected and well-paid positions fill the ranks of the less priviledged ones. The reason is called "rent."

QuikClot, your posts are like a breath of fresh air.

I read the OP the same way..."Who's going to be around to play 'Stepin Fetchit' when I become a doctor?"

fang: Were you a nurse? Do you know what nurses do? Do you even know any nurses personally? I'd love to know what your definition of a "real nurse" is. Enlighten me...I've been an RN for over twenty years, but maybe I've missed something.

 

[njbmd]

Seems like many threads get into debates about the differences between MD's and nurses, PA's, etc, and every aspect of their respective roles.

My observation is that everyone seems to want to be the doctor--
1. Nurses with PhDs and some PA's want to call themseves "Doctor whatever"
2. Everyone wants to wear the white coat
3. There is a turf war going on about who can prescribe what in which state

If everyone wants to be a doctor and keeps struggling so desparately to take over doctors' roles, who is going to be the nurse?? If I were in the hospital, I'd rather have a great nurse and a competent doctor than the other way around, assuming I didn't have something unusual or hard to manage. Good nurses are there for their patients no matter what kind of smelly, embarassing, or offensive thing is going on-- someone needs to be nearby, in case they suddenly need CPR, need to vomit, need an IV, or just need to talk. The new trend seems to be to jettison all of that in search of more power, prestige, and self-importance -- they think that mimicing doctors' roles will bring all that. If I'm ever sick and need some help, God forbid I get some nurse who wants to listen to my heart all the time and make suggestions about BP meds.

We need to encourage people who want to prescribe medication and act as independant practitioners to go to medical school, and be clear about what practicing medicine and practicing nursing means-- they should not be synonymous... real nurses are too important.

Hi there,
Anyone who has earned a doctorate-level degree can be addressed as Doctor. The term "Doctor" does not equal physician and thus everyone who has the title of Doctor is not a physician.

Physician assistants, nurses with doctoral degrees and pharmacists with doctoral degrees generally are NOT interested in being physicians. They have spent some time learning their respective crafts and are part of the healthcare team. No physician in today's climate of practice, is able to perform every role in the care of a patient. The physician is the director of the healthcare team and that is their role.

Independent practice does not equal physician. There are many kinds of independent practicioners that are non physicians and are not physician equivalents. These include dentists, chiropracters, podiatrists, optometrists and others. Again, they participate in healthcare but are not physicians and are not physician-substitutes.

In hospital practice, people who are addressed as "Doctor" are those who hold the MD or DO degree and are liscensed to practice medicine in the state of their choice. Most of the nurses that I work with have no interest in the practice of medicine or being called "Doctor". There are some who have an interest in the practice of medicine and thus will pursue medical school like anyone else who wishes to become a physician.

The nice thing about healthcare today is that there are many roles and careers out there that enable you to work with patients in many aspects. If you like one-on-one care with your patients, there is respiratory therapy. If you like learning about pharmaceuticals and their actions, there is pharmacy. If you like the care of patients, there is nursing.

Believe me, as a physician, I start IVs, turn patients, help with baths (good way to see everything), prescribe medications, do CPR, help with vomiting patients, place NGTs, and other things that nurses may do also. While our jobs frequently overlap, we work from different aspects for the good of the patients. I have never run into a nurse or a physician assistant that wanted to mimic a physician.

njbmd

 

[fang]

QuikClot, your posts are like a breath of fresh air.

I read the OP the same way..."Who's going to be around to play 'Stepin Fetchit' when I become a doctor?"

fang: Were you a nurse? Do you know what nurses do? Do you even know any nurses personally? I'd love to know what your definition of a "real nurse" is. Enlighten me...I've been an RN for over twenty years, but maybe I've missed something.

No, I specifically *don't* mean who will play "stepin fetchit". I'm pointing out that nursing is a legitimate profession on it's own with a function that is separate from medicine, it's not "support staff". I know several nurses; they're all happy doing what they do, are incredibly patient people, and take a lot of crap from doctors. Nurses fulfill a different role right now, and I think that role is suffers when you start thinking of an RN as a lesser form of MD, and then try to correct the balance. Here's what the ANA says:

"The ANA is at the forefront of policy initiatives pertaining to health care reform. Among the priority issues are: a restructured health care system that delivers primary health care in community based settings; an expanded role for registered nurses and advanced practice nurses in the delivery of basic and primary health care..."

So if some percentage of nurses graduating now go this route, who is going to replace nurses who work in hospitals and clinics? They already seem overworked.

I'd love to hear from current or former nurses about this trend. I'm not going to apologize for the way I worded my 1st post... it's a legitimate question, and I don't think it should be disparaging to people in other healthcare professions to ask it.

 

[fang]

Hi there,
Anyone who has earned a doctorate-level degree can be addressed as Doctor. The term "Doctor" does not equal physician and thus everyone who has the title of Doctor is not a physician.

Physician assistants, nurses with doctoral degrees and pharmacists with doctoral degrees generally are NOT interested in being physicians. They have spent some time learning their respective crafts and are part of the healthcare team. No physician in today's climate of practice, is able to perform every role in the care of a patient. The physician is the director of the healthcare team and that is their role.

Independent practice does not equal physician. There are many kinds of independent practicioners that are non physicians and are not physician equivalents. These include dentists, chiropracters, podiatrists, optometrists and others. Again, they participate in healthcare but are not physicians and are not physician-substitutes.

In hospital practice, people who are addressed as "Doctor" are those who hold the MD or DO degree and are liscensed to practice medicine in the state of their choice. Most of the nurses that I work with have no interest in the practice of medicine or being called "Doctor". There are some who have an interest in the practice of medicine and thus will pursue medical school like anyone else who wishes to become a physician.

The nice thing about healthcare today is that there are many roles and careers out there that enable you to work with patients in many aspects. If you like one-on-one care with your patients, there is respiratory therapy. If you like learning about pharmaceuticals and their actions, there is pharmacy. If you like the care of patients, there is nursing.

Believe me, as a physician, I start IVs, turn patients, help with baths (good way to see everything), prescribe medications, do CPR, help with vomiting patients, place NGTs, and other things that nurses may do also. While our jobs frequently overlap, we work from different aspects for the good of the patients. I have never run into a nurse or a physician assistant that wanted to mimic a physician.

njbmd

I agree with all of this, except that there IS a big push to further overlap the responsibilities of midlevel practitioners and physicians, and I don't think it's a good trend for our healthcare system.

 

[fab4fan]

Until nursing becomes an attractive career option, shortages will continue.

Why do you think so many nurses are leaving the bedside? This has been discussed at length here; the reasons usually are centered around unreasonable patient loads and lack of respect from physicians and hospital admin.

If you get sick, you should hope there's a nurse there to listen to your heart. Assessment is part of what we do; it's a lot more than soothing fevered brows and holding hands.

 

[albaniandoc]

One of the biggest reasons for nurses leaving the bedside is prick doctors, besides ridiculous patient load and hours.
The problem in nursing is that you get no support. Most doctors treat you like ****, administration is always trying to bend you over and screw you. If it isn't paid time off, it will be health insurance or bonuses, administration is always cutting something to their favor.
I worked as a bedside nurse for one year. I wanted to continue to do so, but then I thought it was just crazy.
So, next time you wonder about nursing leaving do them a favor and treat them nicer. Maybe they will stay.

 

[Blade Plate]

Hi there,
Anyone who has earned a doctorate-level degree can be addressed as Doctor. The term "Doctor" does not equal physician and thus everyone who has the title of Doctor is not a physician.

Physician assistants, nurses with doctoral degrees and pharmacists with doctoral degrees generally are NOT interested in being physicians. They have spent some time learning their respective crafts and are part of the healthcare team. No physician in today's climate of practice, is able to perform every role in the care of a patient. The physician is the director of the healthcare team and that is their role.

Independent practice does not equal physician. There are many kinds of independent practicioners that are non physicians and are not physician equivalents. These include dentists, chiropracters, podiatrists, optometrists and others. Again, they participate in healthcare but are not physicians and are not physician-substitutes.

In hospital practice, people who are addressed as "Doctor" are those who hold the MD or DO degree and are liscensed to practice medicine in the state of their choice. Most of the nurses that I work with have no interest in the practice of medicine or being called "Doctor". There are some who have an interest in the practice of medicine and thus will pursue medical school like anyone else who wishes to become a physician.

The nice thing about healthcare today is that there are many roles and careers out there that enable you to work with patients in many aspects. If you like one-on-one care with your patients, there is respiratory therapy. If you like learning about pharmaceuticals and their actions, there is pharmacy. If you like the care of patients, there is nursing.

Believe me, as a physician, I start IVs, turn patients, help with baths (good way to see everything), prescribe medications, do CPR, help with vomiting patients, place NGTs, and other things that nurses may do also. While our jobs frequently overlap, we work from different aspects for the good of the patients. I have never run into a nurse or a physician assistant that wanted to mimic a physician.

njbmd

I have read numerous postings by njbmd and consider him to be very level headed and an informative individual. I believe there is a place for midlevel providers and often times we expect more from them than what they can deliever. I am disturbed by the constant push from midlevels for increasing their practice rights. I have delt with midlevels and can tell you with first hand experience that midlevel providers are limited in their clinical knowledge. Medical School is challengening in that it forces you to think outside of the box. This where midlevels fail is that forced to think outside of the algorithms they can't figure things out. I have reached this conclusion thoughout numerous interactions with PA and NP. Yes, midlevels have a place in the health care field. As far as increasing their practice rights, this should be done with caution. People with doctoral degree may not be interested in assumming the physician role but is contradicted by their agenda. Why push for increased practice rights if one is not interested in greater responsibility. Often I deal with the statement; "the doctor has not seen the patient." What does this mean? I should talk to the doctor because you will not assume any responsibility for the patient. Why are you here? I see you help the doctor round on his/her patients. Why do you want more responsibility and why do you want to have more practice rights? Do really what to be it? In my mind there are more questions than answers.

 

[OSUdoc08]

Until nursing becomes an attractive career option, shortages will continue.

Why do you think so many nurses are leaving the bedside? This has been discussed at length here; the reasons usually are centered around unreasonable patient loads and lack of respect from physicians and hospital admin.

If you get sick, you should hope there's a nurse there to listen to your heart. Assessment is part of what we do; it's a lot more than soothing fevered brows and holding hands.

Physician shortages are more of a problem, and this will only continue to grow.

There are a number of hospitals that do not even have a physician on staff 24/7, and are led by NP's or PA's only. These hospitals are fully staffed with nurses.

 

[Kilgorian]

The world needs more good nurses. I have nothing but respect for them and what they do. I wish I could do something to change the current tide of worsening shortages. I think I'll start with telling other people to treat them more nicely.

P.S. If you haven't seen the cowbell skit quoted above - it is truly hilarious!

 

[fang]

Until nursing becomes an attractive career option, shortages will continue.

Why do you think so many nurses are leaving the bedside? This has been discussed at length here; the reasons usually are centered around unreasonable patient loads and lack of respect from physicians and hospital admin.

If you get sick, you should hope there's a nurse there to listen to your heart. Assessment is part of what we do; it's a lot more than soothing fevered brows and holding hands.

I usually love your posts on these boards and don't want to get into an argument, but you're really twisting my words around. Sure, listen to hearts, do the assessment, do your (I thought) valued job and do it well. Just don't sacrifice that as a profession to try and overlap your job with a physician's. If you do, someone is really going to need to be there to provide what you're doing now.

Even asking this question assumes nurses, in the role they fill now, are contributing in a major way to healthcare-- that their expertise is needed. It's interesting that a lot of the comments this thread generates seem to assume the opposite: that any opposition to merging the roles of physicians and nurses is an affront to the ability of nurses because as it stands they are "support staff". I disagree. We should make sure people treat each other with respect, work as a team, increase pay, but solving these issues by redefining job roles isn't productive-- it's a social problem that won't be fixed by changing prescribing rights.

 

[fab4fan]

I totally disagree with my profession's stand on expanding nurses' practice rights. Then again, I have always thought that TPTB at the ANA were either nuts or suffering from oxygen deprivation from being way up in that ivory tower.

I know several NPs, and not one of them wants to practice on the same level as a physician. They are perfectly happy right where they are. I think most of this agitating for increasing practice comes from people who haven't seen, let alone laid hands on a patient in decades.

They can push for increased practice rights all they want, but I can guarantee you that if they get what they want, it will only make patients even more confused about their providers, and those advanced practice nurses will still have patients say, "Why didn't you just go to medical school?"

OSUdoc08: What you posted may be true in some areas, but you really need to take a look at the stats on the nursing shortage, and the projected shortfall to come to get a true picture. By the time you're in your residency, you may be alarmed at how difficult finding a nurse has become. The median age of RNs currently practicing is 43y; watch what happens in ten years when those nurses leave the bedside. We're not educating enough students to replace the older nurses, so not only will you have a shortfall, but the floors are going to be staffed by less experienced nurses, too. Maybe you don't care about this since you're in medical school, but really, it will be your problem too, because the nursing shortage will directly impact the care being given to your patients.

fang: I apologize for having misinterpreted your posts. I went back and reread them and see them differently now.

 

[QuikClot]

I usually love your posts on these boards and don't want to get into an argument, but you're really twisting my words around. Sure, listen to hearts, do the assessment, do your (I thought) valued job and do it well. Just don't sacrifice that as a profession to try and overlap your job with a physician's. If you do, someone is really going to need to be there to provide what you're doing now.

Even asking this question assumes nurses, in the role they fill now, are contributing in a major way to healthcare-- that their expertise is needed. It's interesting that a lot of the comments this thread generates seem to assume the opposite: that any opposition to merging the roles of physicians and nurses is an affront to the ability of nurses because as it stands they are "support staff". I disagree. We should make sure people treat each other with respect, work as a team, increase pay, but solving these issues by redefining job roles isn't productive-- it's a social problem that won't be fixed by changing prescribing rights.

I think where my views, and some others on this thread, differ from yours are twofold: the notion that physicians' roles are clearly distinct from non-physicians', and; the notion that allied health professionals are spending a lot of time and energy laying siege to physician priviledges.

In these days of physician assistants, nurse anesthiologists, field intubations and 12-leads, how many tasks are absolutely specific to the physician? Pretty much nothing. Invasive surgery maybe. Yet the healthcare industry grinds on regardless. Responsibilities shifting and changing among allied health professionals has been a constant reality over the past fifty years. Not only is it not "unproductive"; it's essential. I for one do not want to go back to the days where EMS was run by funeral homes and you had to have verbal orders to start an IV (some states are still like that ).

Secondly, while there may be instances of allied health professionals agitating for a wider scope of practice, I don't see this as a major issue -- apart from whether it is a good or a bad thing. It's kind of like Fox's supposed "War on Christmas": you can find a few examples of people going after some prescription rights, or wanting to be called "doctor," but that does not a movement make -- certainally not enough of one to endanger efforts to reform healthcare.

 

[fab4fan]

The world needs more good nurses. I have nothing but respect for them and what they do. I wish I could do something to change the current tide of worsening shortages. I think I'll start with telling other people to treat them more nicely.

P.S. If you haven't seen the cowbell skit quoted above - it is truly hilarious!

Thanks! And that cowbell skit is truly one of the best moments from "SNL."

PS: I'm just down the road from you in Lancaster!

 

[SuperTrooper]

1. Nurses with PhDs and some PA's want to call themseves "Doctor whatever"

You can get a Ph.D. in nursing?!

What are the research topics? Analysis of the best way to clean diarrhea off the buttcheeks of old men?

 

[fab4fan]

You can get a Ph.D. in nursing?!

What are the research topics? Analysis of the best way to clean diarrhea off the buttcheeks of old men?

And for every post from docs who get it, there are ones like this.

 

[Beau Geste]

I have read numerous postings by njbmd and consider him to be very level headed and an informative individual.

njbmd is a woman. And she's also a surgery resident.

 

[SuperTrooper]

And for every post from docs who get it, there are ones like this.

I'm just joking. I know there are academic nurses who do a lot of really important research. Oh yeah, and i'm not a med student, i'm a dental student.

Anyhow, sometimes i have difficulty understanding why people are interested in nursing. I've volunteered in hospitals quite a bit, and it seems that nurses spend almost half their time cleaning, disinfecting, moving stuff, etc. And a lot of these patients are so out of it, or pissed off to be in the hospital to begin with, that I can't see how nurses can take pleasure when they do directly help them (which i'm sure is a big reason people go into nursing).

 

[deleted87716]

i'm a dental student...sometimes i have difficulty understanding why people are interested in nursing...a lot of these patients are so out of it, or pissed off to be in the hospital to begin with, that I can't see how nurses can take pleasure when they do directly help them.

I hope you're not expecting everybody to be overjoyed to be in your dental chair.

 

[Beau Geste]

I'm just joking. I know there are academic nurses who do a lot of really important research. Oh yeah, and i'm not a med student, i'm a dental student.

Anyhow, sometimes i have difficulty understanding why people are interested in nursing. I've volunteered in hospitals quite a bit, and it seems that nurses spend almost half their time cleaning, disinfecting, moving stuff, etc. And a lot of these patients are so out of it, or pissed off to be in the hospital to begin with, that I can't see how nurses can take pleasure when they do directly help them (which i'm sure is a big reason people go into nursing).

A lot of the nurses I know do it for continuity of patient contact. When they say they take care of people, they REALLY take care of people, and are around a patient for their whole shift, and take care of a set number of patients on their hall, ward, etc.

 

[fab4fan]

I'm just joking. I know there are academic nurses who do a lot of really important research. Oh yeah, and i'm not a med student, i'm a dental student.

Anyhow, sometimes i have difficulty understanding why people are interested in nursing. I've volunteered in hospitals quite a bit, and it seems that nurses spend almost half their time cleaning, disinfecting, moving stuff, etc. And a lot of these patients are so out of it, or pissed off to be in the hospital to begin with, that I can't see how nurses can take pleasure when they do directly help them (which i'm sure is a big reason people go into nursing).

Oh, I get it. Ha. Ha. Ha. Remind me to post some of the hackneyed jokes I've heard about dentists.

Are you even sure the people you saw doing nothing but "cleaning, disinfecting, moving stuff..." were even nurses? These days, everybody wears scrubs, housekeeping included.

Why are you even posting about nurses, since you obviously know next to nothing about the profession and aren't even going to be working with them? Were you just having a random neural firing, maybe trying to be cute? If it was the latter, it didn't work.

And yes, there are some academic nurses who do "really important research." Thanks for the backhanded compliment.

 

[fab4fan]

I'm just joking. I know there are academic nurses who do a lot of really important research. Oh yeah, and i'm not a med student, i'm a dental student.

Anyhow, sometimes i have difficulty understanding why people are interested in nursing. I've volunteered in hospitals quite a bit, and it seems that nurses spend almost half their time cleaning, disinfecting, moving stuff, etc. And a lot of these patients are so out of it, or pissed off to be in the hospital to begin with, that I can't see how nurses can take pleasure when they do directly help them (which i'm sure is a big reason people go into nursing).

Please promise to stay in VT. I'm still trying to work up the courage to go to the dentist, and the last thing I want to do is have to deal with someone like you. I'd like to keep several states' distance between us, thank you very musch.

 

[SuperTrooper]

I hope you're not expecting everybody to be overjoyed to be in your dental chair.

no, i'm not.

But with dentistry it's not always going to be uncomfortable. One visit you may do a crown and the patient just wants it to be over with. The next visit is just a check-up, and they tell you what a great job you did. As fab5 pointed out, i'm not very edumucated when it comes to nursing; but it seems to me that the majority of nurse/patient contact experiences are singular. Unless of course you're a dialysis nurse, and you see the same people every other day for years, and i'm sure there's other examples.

 

[TacoStand]

If everyone wants to be a doctor and keeps struggling so desparately to take over doctors' roles, who is going to be the nurse??

Just an observation from my time volunteering in 2 ERs. Most of the ER techs are going to nursing school. It seems like this is a constant cycle. Many of them that I know are working at night, going to school in the day and have 1-2 kids. Their dedication is inspiring to me.

I hope that as a physician I will remember the nurses, techs, and others, and not develop an authoritian, "I'm the doc" attitude. The doctor still flies the plane, but his/her attitude toward the team members around them can make a big difference in the care that a patient ultimately receives.

 

[JimmyG]

no, i'm not.

But with dentistry it's not always going to be uncomfortable. One visit you may do a crown and the patient just wants it to be over with. The next visit is just a check-up, and they tell you what a great job you did. As fab5 pointed out, i'm not very edumucated when it comes to nursing; but it seems to me that the majority of nurse/patient contact experiences are singular. Unless of course you're a dialysis nurse, and you see the same people every other day for years, and i'm sure there's other examples.

Examples for you:
ICUs of all areas, LTACHs, Rehab hospitals, Acute care hospitals, Hospice nurses (God bless them), Home Health Nurses, School nurses, Wound Care nurses, nurses that do education with patients, such as diabetes education, etc. etc. etc.

I have such a respect for nurses and all that they do for the patients. I am not a nurse, but the reason I am 20 pounds overweight is due to the excessive gifts of food that patients and families give to the nursing staff in our hospital as their token of thanks. Yes, I thank my dentist for giving me a beautiful crown, just as patients will thank their doctors for performing a successful surgery, procedure, etc. However, patients know who's there for them to answer questions, explain procedures and tests and to give them care 100% of the time when the physicians are not available. And that relationship, although it may range from days to weeks to months, will be everlasting for that one patient.

 

[MollyMalone]

I think your observation is incorrect.

The very great majority of nurses are nurses because they want to be nurses. It's a small subset of nurses who want to go on for advanced practice degrees. The debate about the role of midlevel providers is a legitimate one and I can see the logic of many different points of view, but to imply that everyone who wants to be a midlevel provider wants to be a doctor is simply incorrect. And the number of people going into advanced practice is far too small to be a significant cause of a shortage of nursing personnel.

Nurses who want to be doctors go to medical school. I hope you're not implying that those who discover that they would be happier using their talents in medicine instead of nursing should not pursue that avenue!

 

[SuperTrooper]

Examples for you:
ICUs of all areas, LTACHs, Rehab hospitals, Acute care hospitals, Hospice nurses (God bless them), Home Health Nurses, School nurses, Wound Care nurses, nurses that do education with patients, such as diabetes education, etc. etc. etc..

ICUs, Acute Care? I was trying to say that most people's relationships with nurses don't last very long. Like I may get shot, and be in hospital for a few days, but afterwards I'll never see the nurse that cared for me. But your examples of school nurses and home health nurses are good - I'd be more interested in that if I became a nurse because you might be able to develop longer relationships.

 

[JimmyG]

ICUs, Acute Care? I was trying to say that most people's relationships with nurses don't last very long. Like I may get shot, and be in hospital for a few days, but afterwards I'll never see the nurse that cared for me. But your examples of school nurses and home health nurses are good - I'd be more interested in that if I became a nurse because you might be able to develop longer relationships.

Well, I can tell that you are going into dentistry because you value "longer relationships" with your patients. It's not fair however to question the career choice of a nurse because having a long term relationship is not their top priority in career satisfaction. Bless the nurses who are willing, and do a good job, of caring for those individuals for whatever short period they may see a patient. They do it because they care and it challenges them, not because they are trying to get a relationship out of the deal.

 

[Beau Geste]

Don't forget about nursing homes, camps, military, corporate, psych, rehab, etc. There are a gazillion different areas a nurse can work in.

Maybe we should let the nurses on this board explain more about nursing.

 

[Krazykritter]

I have read numerous postings by njbmd and consider him to be very level headed and an informative individual. I believe there is a place for midlevel providers and often times we expect more from them than what they can deliever. I am disturbed by the constant push from midlevels for increasing their practice rights. I have delt with midlevels and can tell you with first hand experience that midlevel providers are limited in their clinical knowledge. Medical School is challengening in that it forces you to think outside of the box. This where midlevels fail is that forced to think outside of the algorithms they can't figure things out. I have reached this conclusion thoughout numerous interactions with PA and NP. Yes, midlevels have a place in the health care field. As far as increasing their practice rights, this should be done with caution. People with doctoral degree may not be interested in assumming the physician role but is contradicted by their agenda. Why push for increased practice rights if one is not interested in greater responsibility. Often I deal with the statement; "the doctor has not seen the patient." What does this mean? I should talk to the doctor because you will not assume any responsibility for the patient. Why are you here? I see you help the doctor round on his/her patients. Why do you want more responsibility and why do you want to have more practice rights? Do really what to be it? In my mind there are more questions than answers.

LOL...in all these posts you have read, you made a bad assumption....njbmd is a woman.

 

[MJB]

I get the feeling I won't have a problem respecting Nurses as I go through school and move into the new career...several reasons..

- I'm married to one...she wants to eventually get her first assist licensure

- I've lived in the real world and been treated by all sorts, including oncology nurses.

- I'm smart enough to know that a nurse with 20 years experience is pretty darned knowledgeable and I can probably learn something from that person.

As for them advancing their degrees, I think it's great...why would someone NOT want to improve themself?

 

[fab4fan]

SuperTrooper wrote:

As fab5 pointed out, i'm not very edumucated when it comes to nursing...

"fab5"...hope you become much better at dentistry than you are at comedy. On second thought, your wanting to be a dentist in part because of valuing "long term relationships" is downright hilarious for a variety of reasons.

I appreciate the sentiments from others here.

 

[fab4fan]

ICUs, Acute Care? I was trying to say that most people's relationships with nurses don't last very long. Like I may get shot, and be in hospital for a few days, but afterwards I'll never see the nurse that cared for me. But your examples of school nurses and home health nurses are good - I'd be more interested in that if I became a nurse because you might be able to develop longer relationships.

Maybe you wouldn't see those nurses again, but because there were nurses to care for you when you got shot you do get to live to see another day.

Step away from the nitrous, Sparky. You make no sense at all.

 

[caroladybelle]

ICUs, Acute Care? I was trying to say that most people's relationships with nurses don't last very long. Like I may get shot, and be in hospital for a few days, but afterwards I'll never see the nurse that cared for me. But your examples of school nurses and home health nurses are good - I'd be more interested in that if I became a nurse because you might be able to develop longer relationships.

Honey,

Given the personalities of people who get shot, they tend to be repeaters, if they aren't DOA.

And with the nature of many illnesses, there are a lot of repeaters. Ortho has their frequently fallers. Neuro the repeated strokes, the quads/paras with frequent complications, seizure disorders. Nephrology has its' chronic renal failures and their complicatons. And lets not even discuss psych. frequent flyers.

As an Onco/Hemo nurse, probably about 75%-80% of my patients are repeaters, unfortunately. And given the nature of leukemic induction or bone marrow transplant, they may be in for 1-3 monthes for just one stay. I may have seen them get married, and have arranged that they would have privacy for their honeymoon. And I may be there when they die. The MD wasn't there

That sort of continuity beats out the 10-20 minutes a year my MD sees me.
--------------------------------------------------------------------------
If the continuing nursing shortage worsens, well I guess MDs will just have to start taking the patients home with them. Or possibly stop being such jerks, that nurses are quitting the profession in droves. You know...like acting like all we do is handle code browns, and making tacky jokes about it.

 

[QuikClot]

Are younger doctors better about respecting nurses? Or is the med school process still turning out arrogant a$$holes by the gross?

 

[caroladybelle]

Are younger doctors better about respecting nurses? Or is the med school process still turning out arrogant a$$holes by the gross?

The a&*hole factor is a lot lower, but still quite present. It really depends on the state, also or the teaching facility.

GA and FL abounds with jerks. FL has cornered the market on old jerks and jerks with bad handwriting, worse spoken English, and atrocious manners. While it may be stereotyping, I will never travel to the middle east give the way that the MDs act when they are here. In both FL and GA, I dealt with MD temper tantrums that rival a bratty two year old's, MDs that curse for no good reason, and the throwing of charts.

In regards to house officers:

Harvard MDs at BIDMC are wonderful, Cornell is great, HUP efficient and easy to deal with. TJUH - the floor MDs are cool, but the ED ones can be a royal pain. Einstein MDs are bit more snooty than most, as are Hopkins MDs but are tolerable. I have heard that Yale is one of the worst, but do not know from personal experience. Travelers avoid that facility like it has ebola.

The only time I got an intern in major hot water because he was a total jerk was at TJUH. And given the treatment that he got from the Attending and staff, he paid for it.

 

[Vox Animo]

It's nice to read a thread that has informed people (mostly) commenting on all sides of the issue. I have gotten a lot of really good information. Most of you seem to know what your talking about.

What worries me, however, about the future is the role of the primary care physician. I would love to be a pediatrician, but due to managed care and a huge shortage it may not be cost-effective for a doctor to see a patient. Most of the people I know that were pre-med and switched to nursing or p.a. was because they thought doctor's had too little interaction with patients.

I would hate to due all this work to become a doctor than spend most of my time signing off on someone else's work. I know most nps and p.a. are competent. Just spending my entire week overseeing pas and nps that see patients doesnt seem worth it. That would make me a foreman not a doctor. And my dad wanted me to go to college so I wouldnt end up as a foreman, like he is (not that there is anything wrong with that).

Just a thought not intended to demean anyone or start an arguement.
What do you all think about this?

 

[deleted87716]

What do you all think about this?

I think you're painting an unlikely scenario. Who knows what the future holds? I wouldn't bet my future happiness on what you think might or might not happen decades from now. Be a pediatrician, if that's what you really want to do.

 

[Vox Animo]

I respect nurses and have nothing against there field. However there is such a shortage that some things are happening that I don't like. Up north some of my friends that are in programs are required to have a high GPA and need to get an 80% or better in every class. That school is cranking out nothing but high quality nurses who are going to improve healthcare.

However at my school in, there are some pre-nursing students that have the who gives a **** attitude i want to money, and are getting c-'s with the curve in their classes and are getting accepted into programs. It just bothers me because some of these people that i have seen are not competent and are going to hurt people in their profession, but there is such a shortage that lesser schools let them in. If i was a nursing student this would piss me off. I would not want to go to a medical school that allowed students in with c averages, thats just asking for a law suit.

So here is your answer, some doctors have animosity toward some nurses because these cases, though they are minor, are what they see alot of in undergrad.

 

[QuikClot]

I respect nurses and have nothing against there field. However there is such a shortage that some things are happening that I don't like. Up north some of my friends that are in programs are required to have a high GPA and need to get an 80% or better in every class. That school is cranking out nothing but high quality nurses who are going to improve healthcare.

However at my school in, there are some pre-nursing students that have the who gives a **** attitude i want to money, and are getting c-'s with the curve in their classes and are getting accepted into programs.

I'm very suspicious of this account. It may be that you're not getting good information on the pre-nursing students -- just like SDN newbies sometimes think everyone else got a 35+ MCAT and studies five minutes a night.

Nursing programs are highly competetive in my part of the country. I think they are most places.

So here is your answer, some doctors have animosity toward some nurses because these cases, though they are minor, are what they see alot of in undergrad.

I don't very much that the reason doctors disrespect nurses is that they had bad experiences with pre-nursing students. I'm starting in the fall, and I never met one on campus. Nor would it make any sense whatsoever; MD programs, like nursing and every other grad program, have slackers who somehow got in.

 

[Vox Animo]

I'm very suspicious of this account. It may be that you're not getting good information on the pre-nursing students -- just like SDN newbies sometimes think everyone else got a 35+ MCAT and studies five minutes a night.

Nursing programs are highly competetive in my part of the country. I think they are most places.



I don't very much that the reason doctors disrespect nurses is that they had bad experiences with pre-nursing students. I'm starting in the fall, and I never met one on campus. Nor would it make any sense whatsoever; MD programs, like nursing and every other grad program, have slackers who somehow got in.

Very true. Where I am originally from the nursing schools are very competitive. However, my school is in a somewhat rural area, and things are different. The slacker thing is definatley a factor in all fields. I based some of my observations off of anatomy class. I am a TA and a have graded all the practicals, and I know individuals that routinely failed exams and got accepted somewhere. What I have seen, is not a enough to make broad biases across the whole country. However, talk to students you know that work in hospitals in rural areas and they will confirm some of what I said.

I think I am gonna edit my post.

 

[caroladybelle]

I respect nurses and have nothing against there field. However there is such a shortage that some things are happening that I don't like. Up north some of my friends that are in programs are required to have a high GPA and need to get an 80% or better in every class. That school is cranking out nothing but high quality nurses who are going to improve healthcare.

However at my school in, there are some pre-nursing students that have the who gives a **** attitude i want to money, and are getting c-'s with the curve in their classes and are getting accepted into programs. It just bothers me because some of these people that i have seen are not competent and are going to hurt people in their profession, but there is such a shortage that lesser schools let them in. If i was a nursing student this would piss me off. I would not want to go to a medical school that allowed students in with c averages, thats just asking for a law suit

There are a whole lot of "prenursing" students that will never make the cut to Nursing school. And of those that do, many will not pass. And again, just because they pass does not mean that they will pass NCLEX.

Out of 500 qualified (had acceptable grades/test results/criminal background checks) nursing applicants for my program, 61 made the cut. Of those, 25 graduated and all past Boards.

The weeding out starts earlier. At my school, 40 started into A&P I (not all were prenursing), 16 passed on the first attempt, and 11 of those survived A&P II. So those the vast majority of those "prenursing" students will never make it to Boards.

The other thing to remember as far as the "I want money" attitude, is look at yourselves. How many med students are doing their schooling purely for the joys and benefits of caring for the ill, and not looking for substantial compensation for it? They often carry the #$% attitude. Quite frankly, if the money motivates someone enough that they survive nursing school and acquire good skills, it is not a problem. The Public needs to get over the "Nurses should do nursing for the pure angelic pleasure of caring for the ailing" BS. It isn't that emotionally rewarding with today's public and we are not little pure handmaiden angels that just hold hands and comfort. It is frequently ugly, painful, dirty, dismal work...that should pay us well.

In the words of "Faith No More" - We care alot, It's a dirty job but someone's gotta do it.

And if you are complaining about being deskilled, merely signing off on PA/NPs, virtually the same situation is being increasingly forced on RNs. "Team" nursing with it's one RN for 10-20 or more patients, an LPN to give meds, and UAPs to do the physical tasks. If one of those screws up, it is going to be the RNs license that takes the major hit. Meantime, states are trying to permit "medication assts.", meaning that a poorly trained, minimally educated aide give meds on your patients.

Most of us value our time with our patients, and quite frankly I would rather never work with UAPs. It is easier for me to do it myself, than not chase an aide all over creation to find out crucial issues. But it is becoming increasingly difficult to find primary care positions.

 

[fab4fan]

You hit the nail on the head, caroladybelle. Altruism doesn't pay the bills.

 

[fang]

Interesting to see how this thread has morphed around. One thing though-- it was not intended as a nurse-bashing thread, though some people seem to have interpreted it that way. Just wanted to make it clear that I was interested in debating the trend, not delivering a personal criticism.

Also, maybe part of this problem could be solved by more nurses and nursing students going to medical school...perhaps they could get some credit for similar classes, but keep the admissions standards the same. That way more phsycians would understand what nurses do, and "advanced practice" would not be a point of contention.

 

[Vox Animo]

to caroladybelle:

Thanx for the input. There is a lot I don't know about nursing school that you cleared up for me. And I would like to clarify that I have no problem with nurses being highly paid. I have no problem with anyone who works hard for a living to be highly paid. I understand that it is an extremely difficult job, they have to put up with alot of BS and believe they should be paid what they are. And I did not mean to intentionally bash the nursing profession.

I agree, there are plenty of pre-med that are doing it for the money. However, if money was one's soul goal, I don't think one would last long at either profession.

BTW, what is a LPN or UAP?

 

[fab4fan]

LPN=Licensed Practical Nurse. Less education than an RN, some practice limitations which vary from state to state. Practice under the supervision of an RN.

UAP=Unlicensed Assistive Personnel. Can be the equivalent of a nurse's aide/nurse tech. Allowed to do some tasks and direct patient care, but must be under the supervision of an LPN/RN; can't do things such as give meds, skilled procedures. Does basic personal care, vitals, in some cases may be instructed to do caths, EKGs, draw blood.

fang: I don't understand the part about nurses and nursing students going to medical school so doctors will understand what nurses do. Can you explain?

 

[montessori2md]

I think mds who think nursing is distasteful are going to have a hard time relating to the nurses they work with -it's a lot easier to get on with your coworkers if you can put yourself in their shoes for at least a day and be able to think beyond "gosh, this sucks".

I also think that advanced practice nursing can help to solve some of the impending shortfall -if you believe there are many opportunities for advancement, and maybe even to move above the bedside running your butt off sort of day, then you might be more likely to start nursing to begin with, rather than just saying "gosh, I couldn't do this my whole life".

I've been in a career not unlike nursing -early childhood ed, which is also a lot of cleaning and caregiving, and it's great (I mean, you do get to teach kids how to read and multiply, you help their parents solve basic problems like how to get through a trip to the store without wanting to kill their child, etc), but I could not physically do this my whole life, I couldn't live on my income without my spouse, and I would mentally disintegrate. I imagine many nurses who jump into advanced practice are similiarly motivated.

 

[gujuDoc]

I work with nurses all the time. Very few of them want to be doctors. Lots of them want to work less and make more . . . but I have never seen anyone express envy of the doctors.

(I hope) I don't understand what you mean by "who's going to be the nurse?" It seems like you are saying "Who's going to be subordinate to the doctor and carry out menial functions?" but that is not really what RNs do, nor has this been their role for some time.

There are CNAs, monitor techs, ED techs, etc. to act as support staff. It seems to me your question is like asking "If everyone wants to be a partner at the law firm, who's going to be the associates/paralegals/secretaries?" And the answer is the same as it has always been; people who can't get the most respected and well-paid positions fill the ranks of the less priviledged ones. The reason is called "rent."

Good post. I have met quite a few nurses coming back to school to take the prereqs and get a bachelor's, and taking the MCAT to get into med school. These people all tell me that in theory that the doctors and nurses and all involved in healthcare should be treated equally, but in practice the treatment of nurses is very poor.

So the respect thing has something to do with it. Many of them want independence and to be more involved in diagnosis so they return to school.