Whats going ON... Doctors helping CRNA and NP students more.

[desijigga]

1st Incident - On Anesthesia the CRNA students get priority over rooms, and if we want any teaching we have to ask the CRNAs, because the ANES docs are never to be found. I admit our hospital is a community type, with few residencies (ER, IM, OBgyn, Surgery) and no fellowships. I wanted to bag a patient while there were running ECTs, but the ANES told me to move aside for the CRNA student. WTF!!

Now on my Peds rotation which is at a clinic. My pediatrics doctor actually went and grabbed the NP student (who was on the other side of the clinic), and started teaching her and showing her how to work up a kid with this disorder, when I was right next to him and it was my patient. The kid had early symptoms and was positive for Juvenile Arthritis.

I am all for midlevels helping out, but we cannot give them pretty much autonomy over everything. This NP is not a good one either, She would make a big deal about little sinus problems, but just brush off major issues. So many parents would come back and complain that the NP didn't take their kid seriously. She was basically the 2nd doctor at the clinic, prescribing, ordering tests, the whole sha bang..I WOULD never want my kid to be seen by any midlevel provider. Heck if I am getting charged 200 bucks a visit I want to see the doctor. Scary part is the NP saw about 30-35 pts a day while the doctor only looked at 20 pts on the busiest day.

What can I do, Should I go talk to my Dean of Rotations?

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[traxxradiorocks]

Maybe it's just you. Most of the doctors teach the students who show the most interest and they would in general give priority to med students. Never has one doc given priority to a NP student over me.
Show more interest in what they do.

1st Incident - On Anesthesia the CRNA students get priority over rooms, and if we want any teaching we have to ask the CRNAs, because the ANES docs are never to be found. I admit our hospital is a community type, with few residencies (ER, IM, OBgyn, Surgery) and no fellowships. I wanted to bag a patient while there were running ECTs, but the ANES told me to move aside for the CRNA student. WTF!!

Now on my Peds rotation which is at a clinic. My pediatrics doctor actually went and grabbed the NP student (who was on the other side of the clinic), and started teaching her and showing her how to work up a kid with this disorder, when I was right next to him and it was my patient. The kid had early symptoms and was positive for Juvenile Arthritis.

I am all for midlevels helping out, but we cannot give them pretty much autonomy over everything. This NP is not a good one either, She would make a big deal about little sinus problems, but just brush off major issues. So many parents would come back and complain that the NP didn't take their kid seriously. She was basically the 2nd doctor at the clinic, prescribing, ordering tests, the whole sha bang..I WOULD never want my kid to be seen by any midlevel provider. Heck if I am getting charged 200 bucks a visit I want to see the doctor. Scary part is the NP saw about 30-35 pts a day while the doctor only looked at 20 pts on the busiest day.

What can I do, Should I go talk to my Dean of Rotations?

 

[mglavin]

Show more interest in what they do.

How about the 10s of thousands of dollars more he is likely paying for his education compared to the CRNA or Np student, that seems like a lot of interest being shown to me.

I say talk to your preceptor, clerkship director, dean in that order.

 

[SIGMACHIGUY]

While it seems screwed up, the CRNA students will be practicing independently (or close to it) as soon as they graduate -- you still have residency, should you even choose and get accepted into it.

Don't get me wrong, I hate them and will (likely) never hire one, but from the perspective of patient safety, they need to get the most out of their limited clinical training.

WELL PUT.

 

[McGillGrad]

What can I do, Should I go talk to my Dean of Rotations?

Yes, go and discuss this with your dean. The point of your rotation is to learn and if the staff is not interested in teaching med students, it is their prerogative, but that means your school should not pay them to train med students.

 

[Dirt]

1st Incident - On Anesthesia the CRNA students get priority over rooms, and if we want any teaching we have to ask the CRNAs, because the ANES docs are never to be found. I admit our hospital is a community type, with few residencies (ER, IM, OBgyn, Surgery) and no fellowships. I wanted to bag a patient while there were running ECTs, but the ANES told me to move aside for the CRNA student. WTF!!

Now on my Peds rotation which is at a clinic. My pediatrics doctor actually went and grabbed the NP student (who was on the other side of the clinic), and started teaching her and showing her how to work up a kid with this disorder, when I was right next to him and it was my patient. The kid had early symptoms and was positive for Juvenile Arthritis.

I am not that shocked about the stuff on anesthesia, that is going to be their job soon and you are probably viewed as someone just passing through. Think of them like interns, they get the procedures ahead of you if they need them.

Something smells fishy in the second example though. It sounds to me like this pediatrician just plain doesn't like you. Why couldn't he explain to both of you how to work up a kid for JIA.

 

[myhandsarecold]

awesome. id probably learn a whole of a lot more if my attendings let me be. seriously, most of the time im just sitting there watching them write orders.

 

[Charles_Carmichael]

While it seems screwed up, the CRNA students will be practicing independently (or close to it) as soon as they graduate -- you still have residency, should you even choose and get accepted into it.

Don't get me wrong, I hate them and will (likely) never hire one, but from the perspective of patient safety, they need to get the most out of their limited clinical training.

Let the CRNAs teach the SRNAs. I think physicians need to stop teaching nursing midlevels. Just tell them to "look it up" if they ask a question.

 

[Ableton]

Let the CRNAs teach the SRNAs. I think physicians need to stop teaching nursing midlevels. Just tell them to "look it up" if they ask a question.

This is basically what I'm told every time I ask a question on a rotation...

 

[Charles_Carmichael]

This is basically what I'm told every time I ask a question on a rotation...

I'm sorry to hear that. But I truly think that physicians ought to completely stop teaching nursing midlevels. That second example the OP gave about the pediatrician is nauseating to read about. Please don't sell-out the medical profession. Especially when the nursing midlevels continue to bite the hand that feeds them...

 

[Droopy Snoopy]

While it seems screwed up, the CRNA students will be practicing independently (or close to it) as soon as they graduate -- you still have residency, should you even choose and get accepted into it.

Don't get me wrong, I hate them and will (likely) never hire one, but from the perspective of patient safety, they need to get the most out of their limited clinical training.

Yes by all means get on your knees OP, and don't forget the reach-around. It's your education, so if you feel like you're getting the shaft then you gotta say something. By the same token, if I were a clerkship director this is the kind of thing I'd want to know about and push to change on behalf of my students. God knows we as a profession don't do enough advocating for ourselves, at any level. Some of the opinions expressed on this thread just go to show why physicians get pushed around on everything from healthcare policy and insurance reimbursement to tort reform.

 

[badasshairday]

Something smells fishy in the second example though. It sounds to me like this pediatrician just plain doesn't like you. Why couldn't he explain to both of you how to work up a kid for JIA.

Better yet, why can't an NP be the preceptor for the NP student?

 

[LifetimeDoc]

On my surgery rotation, I took an interest in the intubation part that the student CRNA was doing under the guidance of the anesthesiologist. I started asking questions and even asked if I could try intubation on one of the patients (I had previously seen the anesthesiologist have a student EMT come in the OR and had them practice intubation, and he even told the EMT that doctors know how to intubate and if an MD told you to get out of the was as an EMT, you should let them as they are the experts).

Well, after the patient was intubated and asleep, the anesthesiologist (an MD) took me into the sub-sterile room and proceeded to tell me (actually quietly yell at me) that if I ever asked questions again or asked to do something on the "other side of the curtain", he would have me thrown out of the OR as he has just as much power to do so as the surgeon. He further went on to say that the education of the CRNA and EMTs takes priority over the medical students.

WTF?

 

[McGillGrad]

Unbelievable!

I would have a talk with you clinical dean and make sure they know about this.

AT THE SAME TIME, you are on the surgery rotation so the GAS guys can refuse to teach you.

On my surgery rotation, I took an interest in the intubation part that the student CRNA was doing under the guidance of the anesthesiologist. I started asking questions and even asked if I could try intubation on one of the patients (I had previously seen the anesthesiologist have a student EMT come in the OR and had them practice intubation, and he even told the EMT that doctors know how to intubate and if an MD told you to get out of the was as an EMT, you should let them as they are the experts).

Well, after the patient was intubated and asleep, the anesthesiologist (an MD) took me into the sub-sterile room and proceeded to tell me (actually quietly yell at me) that if I ever asked questions again or asked to do something on the "other side of the curtain", he would have me thrown out of the OR as he has just as much power to do so as the surgeon. He further went on to say that the education of the CRNA and EMTs takes priority over the medical students.

WTF?

 

[gmsquid]

Why all the hate towards CRNAs and NPs? They treat patients and they deserve to. They know what they are doing and patients get great care under them. They may not know every tidbit, but they still do a fine job. Its that you think so highly of your own degree that your support staff won't like you.

 

[McGillGrad]

It sounds like you are being a bit defensive. Are you a NP/CRNA?

Why all the hate towards CRNAs and NPs? They treat patients and they deserve to. They know what they are doing and patients get great care under them. They may not know every tidbit, but they still do a fine job. Its that you think so highly of your own degree that your support staff won't like you.

 

[turkeyjerky]

Why all the hate towards CRNAs and NPs? They treat patients and they deserve to. They know what they are doing and patients get great care under them. They may not know every tidbit, but they still do a fine job. Its that you think so highly of your own degree that your support staff won't like you.

I think the animosity in this thread relates to mid-level involvement taking away from our education. Given the fact that we WILL BE DOCTORS in a few years (and are paying a buttload for the privilege), I think we have the right to be pissed the f^ck off when the np or pa student gets priority.

 

[footcloud]

I was watching a procedure and this nurse goes, "Can I see? I've never seen one before..." and then moves in front of me, obstructing my view. Since I wasn't interested in the field, I was like okay since I didn't want to create animosity. But seriously though, if I don't get hands on experience, I should at least have priority for watching a procedure.

 

[Dr Oops]

This thread makes me scared for the future of our profession. Why the well aren't NPs/CRNAs teaching their own students. Just giving them more ammo to say they can do their jobs just as well asus w/ a fraction are the training

 

[gmsquid]

It sounds like you are being a bit defensive. Are you a NP/CRNA?

Nope, 3rd year med student. Just annoyed at people's egos about their title as MD.

 

[McGillGrad]

Nope, 3rd year med student. Just annoyed at people's egos about their title as MD.

Sounds like what a NP would say.

 

[gmsquid]

Sounds like what a NP would say.

Yep...you got me.

 

[gmsquid]

But somewhere along the way, people who become doctors forgot that all that matters is the care of the patient.

 

[McGillGrad]

But somewhere along the way, people who become doctors forgot that all that matters is the care of the patient.

Did they teach you that in nursing school?

But seriously, you are talking about something totally different. The topic is about education not patient care. That's why no one takes your posts seriously.

 

[gmsquid]

Did they teach you that in nursing school?

But seriously, you are talking about something totally different. The topic is about education not patient care. That's why no one takes your posts seriously.

The posts on this thread are a series of NP/CRNA bashing posts. Ultimately, education's purpose in the health field is patient care. So if an NP/CRNA learns something to help a patient, that's what matters.

 

[Charles_Carmichael]

Why all the hate towards CRNAs and NPs? They treat patients and they deserve to. They know what they are doing and patients get great care under them. They may not know every tidbit, but they still do a fine job. Its that you think so highly of your own degree that your support staff won't like you.

There is not a single well-done study that shows that midlevels provide care equivalent to that of physicians. There are, however, a bunch of studies looking at useless measures like patient satisfaction and equating them to "quality" care.

 

[McGillGrad]

The posts on this thread are a series of NP/CRNA bashing posts. Ultimately, education's purpose in the health field is patient care. So if an NP/CRNA learns something to help a patient, that's what matters.

You seem very emotionally attached to this topic. Therefore, it is difficult to use logic with you. But I'll try.

This thread is about a medical student paying tuition for education at a teaching hospital. It doesn't matter if the attending is teaching the janitor or the NP, if he is not teaching the medical student, then there is something wrong.

Anything else that you "see" in this thread is merely an extension of your personal biases and emotions transplanted in to the thread.

 

[pianoman511]

The posts on this thread are a series of NP/CRNA bashing posts. Ultimately, education's purpose in the health field is patient care. So if an NP/CRNA learns something to help a patient, that's what matters.

So if you were on a rotation with an attending and a NP student was there as well, you would be okay with the NP student getting all the procedures and being the first person to ask/answer questions ? Would you just stand quietly in the background ?

As many others have postulated, why not have NPs & CRNAs teaching their respective students ? That's who they should be learning from. Let's face it, we're practicing medicine, not nursing, and that's what they'll be doing when they graduate. I wouldn't want them to learn the wrong way to do things .

 

[desijigga]

I talked to the clerkship director, but I don't think much is going to change. There are very few pediatricians that take students around my hospital, so guess we just have to deal with it.

 

[Dirt]

This beef is addressed en masse on the anesthesia board.

You have to understand that when you are an attending anesthesiologist, you are supervising these CRNAs and are responsible for their actions. As such it is in your and the patient's best interest to have the best trained CRNA possible. The same exact thing goes for NPs and their supervising physicians.

Trust me when I say that I am weary of mid-level encroachment, however, you better believe that if my patients' outcomes depend upon the skill of mid-level providers that I am responsible for, I am going to ensure they know what the F they are doing.

 

[LifetimeDoc]

This beef is addressed en masse on the anesthesia board.

You have to understand that when you are an attending anesthesiologist, you are supervising these CRNAs and are responsible for their actions. As such it is in your and the patient's best interest to have the best trained CRNA possible. The same exact thing goes for NPs and their supervising physicians.

Trust me when I say that I am weary of mid-level encroachment, however, you better believe that if my patients' outcomes depend upon the skill of mid-level providers that I am responsible for, I am going to ensure they know what the F they are doing.

When a medical student asks a physician a question or asks that sometime he could do an intubation just so he knows how (so that when it becomes necessary, he has at least done it once instead of just on a simulated dummy), that bit doesn't justify taking said student out of the OR and dressing them down for being lower than a mid-level. Unbelievable that Anesthesiologists would treat a medical student going into surgery in such a way. I've lost respect for MD's that put their training program over that of other students. For goodness sakes, they were training random EMTs in intubation, then yelling at med students for asking for the same opportunity!

At least in my situation, the anesthesiologists are not part of my school, and are PAID to train mid-levels only. They obviously feel burdened to deal with medical students. It's a money issue, not a patient best-interest issue.

P.S. What I've observed in the OR is that mid-levels don't go the extra mile to care for the patient. When lunch breaks and the end of the shift come up, they pass off the patient at the drop of a hat. The surgeon doesn't disappear in the middle of the case nor does an anesthesiologist working on a difficult/critical patient, risking the patient's health in some kind of handoff. I've seen countless times when the new person doesn't know what's going on, or is goofing off and not paying attention because "I just came on" the case. Bad for patient outcomes IMHO.

 

[LifetimeDoc]

Unbelievable!

I would have a talk with you clinical dean and make sure they know about this.

AT THE SAME TIME, you are on the surgery rotation so the GAS guys can refuse to teach you.

I guess the anesthesiologist can decide not to teach a medical student. It's their choice. But do we really want to stop teaching doctors, and only train nurse anesthetists? You can't teach both? Why only train nurses? Are med students supposed to be shunned, in some kind of hazing type of atmosphere?

 

[McGillGrad]

I guess the anesthesiologist can decide not to teach a medical student. It's their choice. But do we really want to stop teaching doctors, and only train nurse anesthetists? You can't teach both? Why only train nurses? Are med students supposed to be shunned, in some kind of hazing type of atmosphere?

In this specific case, there could be numerous reasons why the anaesthetists do no want to teach the med students. It could be because they hate med students, or they are paid to teach the CRNA's or the PA's and it is part of their contract. That's a business issue.

On the other hand, I have yet to see anyone refuse to teach me. Maybe the med student rubbed the gas jockey the wrong way. N=1 is not a much to work with.

 

[Dr Oops]

This beef is addressed en masse on the anesthesia board.

You have to understand that when you are an attending anesthesiologist, you are supervising these CRNAs and are responsible for their actions. As such it is in your and the patient's best interest to have the best trained CRNA possible. The same exact thing goes for NPs and their supervising physicians.

Trust me when I say that I am weary of mid-level encroachment, however, you better believe that if my patients' outcomes depend upon the skill of mid-level providers that I am responsible for, I am going to ensure they know what the F they are doing.

why should you even be teaching Nurses, they Should be training their own and we should train our own. What they really should be taught is when they need to call the physician

 

[LifetimeDoc]

In this specific case, there could be numerous reasons why the anaesthetists do no want to teach the med students. It could be because they hate med students, or they are paid to teach the CRNA's or the PA's and it is part of their contract. That's a business issue.

On the other hand, I have yet to see anyone refuse to teach me. Maybe the med student rubbed the gas jockey the wrong way. N=1 is not a much to work with.

You're totally right. Your N=1 has convinced me that medical students should just step aside and let the mid-levels get all of the experience and education. They can just learn it on their own in residency or randomly on patients when they are practicing on their own.

 

[badasshairday]

At least in my situation, the anesthesiologists are not part of my school, and are PAID to train mid-levels only. They obviously feel burdened to deal with medical students. It's a money issue, not a patient best-interest issue.

Those anesthesiologists are sell outs. Unbelievable.

 

[Dirt]

why should you even be teaching Nurses, they Should be training their own and we should train our own. What they really should be taught is when they need to call the physician

There is this saying that is coming to mind, something about cutting off one's nose to spite one's face.

I won't claim personal experience here, but it is not that difficult a concept. CRNAs work under the supervision of anesthesiologists (at least in the non opt-out states). Said anesthesiologists are responsible for what these CRNAs do. These CRNAs will be making decisions that will directly affect patient outcomes. They are "trained" on their own in their programs, but again if a CRNA works for me, I am going to ensure that they know what they are doing. Why? Because to do otherwise is to put my patients in harms way, and makes me a bad doctor.

 

[Charles_Carmichael]

There is this saying that is coming to mind, something about cutting off one's nose to spite one's face.

I won't claim personal experience here, but it is not that difficult a concept. CRNAs work under the supervision of anesthesiologists (at least in the non opt-out states). Said anesthesiologists are responsible for what these CRNAs do. These CRNAs will be making decisions that will directly affect patient outcomes. They are "trained" on their own in their programs, but again if a CRNA works for me, I am going to ensure that they know what they are doing. Why? Because to do otherwise is to put my patients in harms way, and makes me a bad doctor.

If CRNAs are being supervised by anesthesiologists, why would the CRNAs be "making decisions that will directly affect patient outcomes?" The anesthesiologist will be responsible for that. At least, that's how I understand it. Feel free to correct me if I'm wrong.

 

[ZagDoc]

P.S. What I've observed in the OR is that mid-levels don't go the extra mile to care for the patient. When lunch breaks and the end of the shift come up, they pass off the patient at the drop of a hat. The surgeon doesn't disappear in the middle of the case nor does an anesthesiologist working on a difficult/critical patient, risking the patient's health in some kind of handoff. I've seen countless times when the new person doesn't know what's going on, or is goofing off and not paying attention because "I just came on" the case. Bad for patient outcomes IMHO.

I was on call a little while back and we had a late night MVA trauma with hemo-everything that we rushed back to the OR. It was a hairy operation and at one point the attending was doing cardiac massage to maintain perfusion. In the middle of the massage the scrub nurse's replacement comes in and begins gown and gloving and they start doing a "handoff". While we have the chest cracked and are massaging the patient's heart. The surgeon asks where she was going. Her reply "My shift ends at 3." The surgeon's reply "You [insert long string of expletives] are not going anywhere."

She left anyways. Stormed out in a huff as if her rights were violated. The attending told me a few days later she got an email about the incident from admin threatening to reprimand her for "inappropriate behavior in the OR."

What world do we live in?

Now not all scrub nurses and scrub techs are like this. The good ones know when an operation is tense and decline breaks to keep the flow and efficiency of the operation going. They're an incredibly valuable member of the team, really are an asset ot the operation, and are awesome to work with. But the attitude of "welp, see ya later. it's breaktime!" does seem to be pervasive in the OR outside of the MDs present, and the fact that an individual would STAY when things are tenuous is something "extraordinary" speaks something about the current state of things IMHO.

 

[Dr Oops]

There is this saying that is coming to mind, something about cutting off one's nose to spite one's face.

I won't claim personal experience here, but it is not that difficult a concept. CRNAs work under the supervision of anesthesiologists (at least in the non opt-out states). Said anesthesiologists are responsible for what these CRNAs do. These CRNAs will be making decisions that will directly affect patient outcomes. They are "trained" on their own in their programs, but again if a CRNA works for me, I am going to ensure that they know what they are doing. Why? Because to do otherwise is to put my patients in harms way, and makes me a bad doctor.

They are mid levels, physician extenders, they are there to enable YOU to see more patients. Theres no way you can teach them everything they need to know and they dont have the years of med school and residency that you will. So they inevitably have to come to you for decisions to be made which is your job. What your describing is putting them in a position where they think they know everything and think they can act without you, putting your patients in even more danger.

And dont worry you'll get plenty of spite from them once they think they can do everything you can.

If CRNAs are being supervised by anesthesiologists, why would the CRNAs be "making decisions that will directly affect patient outcomes?" The anesthesiologist will be responsible for that. At least, that's how I understand it. Feel free to correct me if I'm wrong.

Every article i read and news report i see with nurses saying theyre able to do everything a physician does but just gets paid less is more scary than anything.

 

[Dirt]

If CRNAs are being supervised by anesthesiologists, why would the CRNAs be "making decisions that will directly affect patient outcomes?" The anesthesiologist will be responsible for that. At least, that's how I understand it. Feel free to correct me if I'm wrong.

You are wrong. CRNAs are the ones in the room with the patients. In many places they are placing lines, intubating, giving the meds, etc. More often than not there is no anesthesiologist in the room. The anesthesiologist is often a phone call away if needed, but is also covering other rooms as well.

They are mid levels, physician extenders, they are there to enable YOU to see more patients. Theres no way you can teach them everything they need to know and they dont have the years of med school and residency that you will. So they inevitably have to come to you for decisions to be made which is your job. What your describing is putting them in a position where they think they know everything and think they can act without you, putting your patients in even more danger.

I am not talking about teaching all the things learned in an anesthesiology residency. I am talking about making sure they are techincally proficient at what their job entails. If that means teaching them a thing or two about intubation or placing lines or whatever else their job entails in a given practice then I will be teaching them that because it is in my and my patients' best interest.

Let me give you an example. You are a pediatrician who employs an NP in your practice. You notice that your NP is prescribing lots of antibiotics for URIs. Are you going to a) Talk to your NP about the things that should prompt one to give antibiotics with a URI, and the reasons for not giving antibiotics to everyone or b) Let them go on writing for antibiotics for every single cold that walks in the door because any information you give them is going to make them think they can do your job? I realize this is a dumb example but if you go with b) you are a bad doctor and an idiot.

 

[Dr Oops]

You are wrong. CRNAs are the ones in the room with the patients. In many places they are placing lines, intubating, giving the meds, etc. More often than not there is no anesthesiologist in the room. The anesthesiologist is often a phone call away if needed, but is also covering other rooms as well.



I am not talking about teaching all the things learned in an anesthesiology residency. I am talking about making sure they are techincally proficient at what their job entails. If that means teaching them a thing or two about intubation or placing lines or whatever else their job entails in a given practice then I will be teaching them that because it is in my and my patients' best interest.

Let me give you an example. You are a pediatrician who employs an NP in your practice. You notice that your NP is prescribing lots of antibiotics for URIs. Are you going to a) Talk to your NP about the things that should prompt one to give antibiotics with a URI, and the reasons for not giving antibiotics to everyone or b) Let them go on writing for antibiotics for every single cold that walks in the door because any information you give them is going to make them think they can do your job? I realize this is a dumb example but if you go with b) you are a bad doctor and an idiot.

By the time the CRNA gets to you in practice they should be proficient at their jobs. You shouldnt have to teach them anything. We have measures in place to do this they should too. They should be teaching their own what it is they need to know/do to be proficient. That onus should not be placed on you.

I would choose option C. Fire the NP and hire a PA. I hired the NP in order to allow me to see more patients, if s/he is doing crap like that I would have to go and council my patients and re do his/her work. Thus defeating the point of having them around and actually making me lose out on productive time i could be seeing other patients.

Heres my scenario:

The patient is intubated and sedated, anesthesiologist is a call away. Patients BP drops and stats drop. Does the CRNA A) proceed to do what they think is right (Cuz hey Dr. Dirt let me do that line that time)? or B) call for the attending backup?

There will always be times when they will need to call the attending for guidance, because like i said before they wont have the training an attending will. Thus teaching them "as much as possible" or "a line here or there" is actually dangerous to the patient. Its outside their scope and training and knowledge base. Its also the reason they think they can work without us. They think hey I know how to do that I can do all this other stuff to without understanding any of the basic science behind it.

 

[Dirt]

By the time the CRNA gets to you in practice they should be proficient at their jobs. You shouldnt have to teach them anything. We have measures in place to do this they should too. They should be teaching their own what it is they need to know/do to be proficient. That onus should not be placed on you.

I would choose option C. Fire the NP and hire a PA. I hired the NP in order to allow me to see more patients, if s/he is doing crap like that I would have to go and council my patients and re do his/her work. Thus defeating the point of having them around and actually making me lose out on productive time i could be seeing other patients.

Heres my scenario:

The patient is intubated and sedated, anesthesiologist is a call away. Patients BP drops and stats drop. Does the CRNA A) proceed to do what they think is right (Cuz hey Dr. Dirt let me do that line that time)? or B) call for the attending backup?

There will always be times when they will need to call the attending for guidance, because like i said before they wont have the training an attending will. Thus teaching them "as much as possible" or "a line here or there" is actually dangerous to the patient. Its outside their scope and training and knowledge base. Its also the reason they think they can work without us. They think hey I know how to do that I can do all this other stuff to without understanding any of the basic science behind it.

I will end our conversation like this. I don't claim to be an attending anesthesiologist, but if you actually spoke to a couple you might realize that your viewpoint and language shows a total and utter lack of maturity and understanding.

Everyone is weary of mid-level encroachment, however isolating, ignoring and overall mal-treatment of mid-levels at the expense of your patients is just plain bad medicine.

 

[Dr Oops]

I will end our conversation like this. I don't claim to be an attending anesthesiologist, but if you actually spoke to a couple you might realize that your viewpoint and language shows a total and utter lack of maturity and understanding.

Everyone is weary of mid-level encroachment, however isolating, ignoring and overall mal-treatment of mid-levels at the expense of your patients is just plain bad medicine.

Well I noticed how you chose not to respond to any of my arguments. Never did I Say treat people like crap because they are mid-levels. All I was saying is that it shouldn't be our responsibility to train them, whether it be for patient safety or otherwise. When they graduate they should by safe to practice or not be able to practice( thatS how it is for us, We are tested thoroughly before we can practice independently). If we (society) are ok w/them practicing independently how come we're not ok w/ them training their own? It's ok for them to "do our job", but they're not good enough to teach?

 

[Stillwater45]

DIRT. You are missing the point. There is an underlying agenda that you are missing. If you truly are a med student then you will understand one day. I was a med student and am currently an Resident. If you look in the media today you will see that nearly every nursing midlevel provider who is authoring or being quoted in most any article states that they are EQUAL or BETTER then Physicians. The lay public or even naive med students may let this slide. THIS IS NOT OK. Midlevel providers play a vital role, but they need to respect the boundaries of their role. To a Physician who sacrificed the better part of their lives to learn the art of medicine, claims of equality from midlevels is a complete insult. There is a raging midlevel nursing agenda. It is very planned and precise attack on physicians in hopes of taking over their rights of practice. Once you experience the responsibility and hardship of medical school, internship, and residency you come to appreciate the true difference in nursing and medical education. Don't discount the value of your education and the sacrifice you made to be where you are. Everyone wants to play doctor. Now, thanks to online degrees - many midlevels are realizing that dream. Should the very physicians that the midlevel associations disrespect with their claims aide in their advancement?

Again, I am not against midlevel providers. I am against midlevel provider associations who claim clinical equality with physicians. Regardless we are in a predicament with the idea of training midlevels. Ultimately it is about the patient, but does the patient benefit if midlevels gain independent practice?

 

[Stillwater45]

.

 

[BabyRN]

But somewhere along the way, people who become doctors forgot that all that matters is the care of the patient.

It does seem that the people becoming doctors forget (or are not taught) that patient care is the priority. I realize that as a nurse, my opinion may not be welcome here, but the posts I've been reading from the future physicians on this forum disgust me, primarily the medical students. The majority sound like immature, egotistical know-it-alls who chose medicine for the prestige. They spend waay too much time daydreaming about how they will personally put "mid levels" in their place and whining about peons wearing lab coats that are longer than theirs. I'm sad for the future of medicine with these up and coming classes of snot-nosed egomaniacs.

 

[Taurus]

It does seem that the people becoming doctors forget (or are not taught) that patient care is the priority. I realize that as a nurse, my opinion may not be welcome here, but the posts I've been reading from the future physicians on this forum disgust me, primarily the medical students. The majority sound like immature, egotistical know-it-alls who chose medicine for the prestige. They spend waay too much time daydreaming about how they will personally put "mid levels" in their place and whining about peons wearing lab coats that are longer than theirs. I'm sad for the future of medicine with these up and coming classes of snot-nosed egomaniacs.

Nurses should look in the mirror. Nurses like to speak out of both sides of their mouths. At the same time that nurses are trying to shame physicians, they're aggressively trying to expand their scope. As has been pointed out many times already, the training of NP's, even with the DNP, is a joke. Get your DNP degree online with as little as 700 hours. Yet, the NP's want to people to think that they are equivalent to physicians. What a joke.

Every time I see an order written by an NP at the hospital, I roll my eyes because they don't have a clue. For an abdominal x-ray, the indication would be "rule out appendicitis, diverticulitis, cholecystitis, bowel obstruction". Did you even look at the patient? Do you even know what questions to ask? Given the volume of patients that a typical hospital goes through, it doesn't take long for an NP to screw up and end up costing the hospital millions of dollars. Here's a recent case where the hospital had to pony up $7.5 million.

TONYA GAGER v. RIVER PARK HOSPITAL

That's why I support every effort undermine nursing in every possible way. Hire PA's and AA's. Kick out the NP's and CRNA's. Increase the medical assistants and LPN's to RN ratio. I also don't support tort reform. Without the threat of lawsuits for screwing up because of inferior training, physicians would have been screwed big time a long time ago by NP's.

 

[All4MyDaughter]

Here's a recent case where the hospital had to pony up $7.5 million.

TONYA GAGER v. RIVER PARK HOSPITAL

Your post is misleading.

Do you have any information about the ACTUAL case that resulted in a "$7.5 million dollar lawsuit"? Because the case you linked to is not that case. It is referenced once but it's not the same case. The Gager case was an EMPLOYMENT case (and the plaintiff lost).

The document you linked to provides no information about the "$7.5 million lawsuit." Without that information, it's impossible to know if the "$7.5 million dollar lawsuit" even involved a NP (it could have been a PA or other midlevel). We don't even know if the hospital actually paid $7.5 million because a "$7.5 million dollar lawsuit" is not the same thing as a "$7.5 million dollar verdict."

All we know is that the "$7.5 million dollar lawsuit" resulted in a new policy that Ms. Gager objected to and her objection ultimately led to the circumstances of HER lawsuit. She lost (twice), not because she was a nurse, but because of simple employment law issues. Her status as a NP is incidental to the finding for the hospital in this case.

 

[45408]

It does seem that the people becoming doctors forget (or are not taught) that patient care is the priority. I realize that as a nurse, my opinion may not be welcome here, but the posts I've been reading from the future physicians on this forum disgust me, primarily the medical students. The majority sound like immature, egotistical know-it-alls who chose medicine for the prestige. They spend waay too much time daydreaming about how they will personally put "mid levels" in their place and whining about peons wearing lab coats that are longer than theirs. I'm sad for the future of medicine with these up and coming classes of snot-nosed egomaniacs.

Oh, please. We can all make up stereotypes, but you're just slinging mud now. Go grind your axe somewhere else.