AA vs. CRNA

[starsweet]

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Hi all,

I'll be going to pharmacy school this fall but I had a question about AAs and CRNAs. What is the difference?

 

[SilverStreak]

Hi all,

I'll be going to pharmacy school this fall but I had a question about AAs and CRNAs. What is the difference?

Look on the ASA and AANA websites for more details. The ASA is the professional organization of anesthesiologists and the AANA the prof organization of CRNAs. Trust me, you don't want to ask this question here because all it's gonna do is start a flame war of bilegerent degradading oppinions on who is better and why. Bottom line, both practice anesthesia, usually in an ACT (anestheisa care team) format where a group of anesthesia providers works together to take care of patients, including anesthesiologists. The anesthesiologists often have supervisory roles in the ACT format, and the definition of supervisory can be very broad in terms of how it is applied to different workplaces. I think that's the most diplomatic way I can say it. In a nutshell, the education and experiences of AAs and CRNAs are usually vastly different, but both end up giving anesthesia to patients doing essentially the same job. There are many variable oppinions as to patient outcomes, but to date, no hardcore infalliable study exists to credit safer anesthesia by delivery of either AA or CRNA.

 

[Monty Python]

Hi all,

I'll be going to pharmacy school this fall but I had a question about AAs and CRNAs. What is the difference?

Since my lawnmower decided to crack the blade, I have nothing else to do, and to save you the effort of a search:

Anesthesia training admission requirements: (and JWK please correct any unintentional errors)

AA: essentially the undergraduate pre-med requirements, standardized test (MCAT I think, perhaps the GRE)

CRNA: BSN degree, 1-2 years of ICU experience, GRE score

Anesthesia training: essentially identical, earning a Master's degree

Anesthesia practice:

AA: practice under direct supervision of anesthesiologist specifically

CRNA:
-- in approximately 25 states, practice completely independent of any physician oversight (per state law). Hospital by-laws can be more restrictive.
-- in the other approximate 25 states, physician supervision of CRNA is required. Hospital by-laws can be more restrictive.
-- no state mandates anesthesiologist supervision of CRNAs, whereas hospital by-laws may.

 

[cfdavid]

Since my lawnmower decided to crack the blade, I have nothing else to do, and to save you the effort of a search:

Anesthesia training admission requirements: (and JWK please correct any unintentional errors)

AA: essentially the undergraduate pre-med requirements, standardized test (MCAT I think, perhaps the GRE)

CRNA: BSN degree, 1-2 years of ICU experience, GRE score

Anesthesia training: essentially identical, earning a Master's degree

Anesthesia practice:

AA: practice under direct supervision of anesthesiologist specifically

CRNA:
-- in approximately 25 states, practice completely independent of any physician oversight (per state law). Hospital by-laws can be more restrictive.
-- in the other approximate 25 states, physician supervision of CRNA is required. Hospital by-laws can be more restrictive.
-- no state mandates anesthesiologist supervision of CRNAs, whereas hospital by-laws may.

Actually, 2 of the 3 current AA programs require the MCAT. The 3rd requires the GRE.


It differs with the specific AA program, but they will also require a biochemistry and physiology course as well (sometimes more than one), and even anatomy prior to admittance. So, I would argue that the pre-req's of an AA program are more rigorous than that of a CRNA program. Those pre-req's are the same ones the science majors take (as well as pre-med), and not the lesser depth courses nursing programs tend to require.

Sure, a year in the ICU is great experience. And I'm sure plenty of CRNA's have had more experience than that in nursing prior to becoming SRNA's. But, I've also noticed that CRNA's like to play up this difference while conveniently ignoring the more rigorous academic requirements of AA programs.

Cheers!

 

[jwk]

Since my lawnmower decided to crack the blade, I have nothing else to do, and to save you the effort of a search:

Anesthesia training admission requirements: (and JWK please correct any unintentional errors)

AA: essentially the undergraduate pre-med requirements, standardized test (MCAT I think, perhaps the GRE)

CRNA: BSN degree, 1-2 years of ICU experience, GRE score

Anesthesia training: essentially identical, earning a Master's degree

Anesthesia practice:

AA: practice under direct supervision of anesthesiologist specifically

CRNA:
-- in approximately 25 states, practice completely independent of any physician oversight (per state law). Hospital by-laws can be more restrictive.
-- in the other approximate 25 states, physician supervision of CRNA is required. Hospital by-laws can be more restrictive.
-- no state mandates anesthesiologist supervision of CRNAs, whereas hospital by-laws may.

Pretty good description there Trin.

I think at last count the opt-out states numbered 14, so that leaves 36 states that some degree of supervision/medical direction/collaboration with a physician is required for CRNA's. No state requires that physician to be an anesthesiologist.

AA's do practice under physician direction, but that doesn't mean the "standing over the shoulder" type. The anesthesiologist is there for induction and emergence, and as needed during the case, which is usually the routine for many anesthesia care team practices. AA's can and do place invasive lines and perform regional anesthesia in many practices. In ACT practices, you wouldn't be able to tell a difference between an AA and a CRNA without looking at their nametag because they're going to function in exactly the same way with the same job responsibilities and compensation for comparable experience.

The big difference for the OP would be that having a degree in pharmacy, they would not also have to go back and get a degree in nursing and then work in an ICU before attending a nurse anesthesia program. They could transition directly to an AA program (currently four with a fifth in 2007).

 

[SilverStreak]

Actually, 2 of the 3 current AA programs require the MCAT. The 3rd requires the GRE.


It differs with the specific AA program, but they will also require a biochemistry and physiology course as well (sometimes more than one), and even anatomy prior to admittance. So, I would argue that the pre-req's of an AA program are more rigorous than that of a CRNA program. Those pre-req's are the same ones the science majors take (as well as pre-med), and not the lesser depth courses nursing programs tend to require.

Sure, a year in the ICU is great experience. And I'm sure plenty of CRNA's have had more experience than that in nursing prior to becoming SRNA's. But, I've also noticed that CRNA's like to play up this difference while conveniently ignoring the more rigorous academic requirements of AA programs.

Cheers!

I do agree with part of what you are saying in regards to nursing pre reqs. Some of what the nursing degrees require are not rigid courses (nursing theory, research, etc.) However, we also take the same hard sciences, I had anatomy, physiology (1 and 2), micro, chem, pharmacology, and pathophysiology all as undergrad classes. I will extend these further in the graduate portion of my education and take in depth anesthesia specific anatomy and physiology, advanced chem, patho, and pharm. I could take the MCAT now with my 2 undergrad degrees I have if that was my career goal. Don't assume that "nursing" classes just for the sake of being a nursing program don't focus on the sciences. We are just as heavily based in the sciences as the AAs are, and the pre med majors.

As far as ICU experience, the average trend is 2-3 years ICU experience in the usual SRNA class. Years of experience can range from 1 year to over 10 years in any given class. Many are quick to downplay that experience. When that sick septic patient rolls in the door and the intensivist is in route, I'm the one hanging drips, getting labs, and getting the ball rolling before he even gets there without any back up from him. It is imperative that I understand what's going on, what the current recommended treatments are, and how to intervene fast. Granted, he will usually intubate when he gets there and place a line, but I've learned to work with what I've got and keep that patient going until he gets there. Same goes for the bypass patient who is bleeding. I call the surgeon to come in, but the management of that patient is left up to me until he gets there. It's a huge responsibility when you've got that patient crashing depending on you until the surgeon gets there to fix the problem. I'm only a bandaid in the interim, but if I don't respond appropriately, aggresively, and in an emergent manner, it won't matter because the patient will die before the surgeon gets there.

An ICU nurse has a unique experience with crashing patients that lends us to being very well suited to managing patients in the OR. Of course, I realize the extra medical expertise the anesthesiologists bring only complements the experiences I've had in the ICU. That's why I think an ACT works so well. All the members are educated professionals and each bring different advantages to the team that complement and make the group better as a whole.

I can't speak to the experience that AAs bring to the table, and I honestly don't have a formed oppinion of them, quite frankly only because I haven't ever worked with or seen any where I work (Tennessee). I only wanted to clarify and expand on a few things about the nursing component of anesthesia delivery because I am a nurse and do know exactly what background we enter our training with.

 

[SilverStreak]

The big difference for the OP would be that having a degree in pharmacy, they would not also have to go back and get a degree in nursing and then work in an ICU before attending a nurse anesthesia program. They could transition directly to an AA program (currently four with a fifth in 2007).

How long does it take to finish an AA program jwk? I think you guys will be a big help with the anesthesia provider shortage coming with the baby boomers aging. It takes a CRNA a minimum of 8-9 years to join the workforce ready to do anesthesia, how do you guys compare to entering the workforce?

 

[Monty Python]

I think at last count the opt-out states numbered 14, so that leaves 36 states that some degree of supervision/medical direction/collaboration with a physician is required for CRNA's.

I think you might be mixing apples and oranges. Opt-out refers strictly to Medicare rules vis-a-vis reimbursement and the degree of required (or not required) supervision. The number of opt-out states is 14.

Opt-out is only an issue in states which, by state law, grant CRNAs independent practice. Opt-out is a complete non-issue in states where state law requires physician supervision of CRNAs.

My previous post was referencing state law requirements of independent versus dependent CRNA practice, and not giving any consideration to reimbursement details. That ratio is roughly 50% of the states allow independent practice (usually the more western / rural states), while the other 50% require a physician officially in the CRNA's chain of command.

 

[stephend7799]

Actually, 2 of the 3 current AA programs require the MCAT. The 3rd requires the GRE.


It differs with the specific AA program, but they will also require a biochemistry and physiology course as well (sometimes more than one), and even anatomy prior to admittance. So, I would argue that the pre-req's of an AA program are more rigorous than that of a CRNA program. Those pre-req's are the same ones the science majors take (as well as pre-med), and not the lesser depth courses nursing programs tend to require.

Sure, a year in the ICU is great experience. And I'm sure plenty of CRNA's have had more experience than that in nursing prior to becoming SRNA's. But, I've also noticed that CRNA's like to play up this difference while conveniently ignoring the more rigorous academic requirements of AA programs.

Cheers!

a year in the icu as a nurse is nothing... if you are not making decisions.. (medical decisions)..

 

[stephend7799]

. When that sick septic patient rolls in the door and the intensivist is in route, I'm the one hanging drips, getting labs, and getting the ball rolling before he even gets there without any back up from him. It is imperative that I understand what's going on, what the current recommended treatments are, and how to intervene fast. Granted, he will usually intubate when he gets there and place a line, but I've learned to work with what I've got and keep that patient going until he gets there. Same goes for the bypass patient who is bleeding. I call the surgeon to come in, but the management of that patient is left up to me until he gets there. It's a huge responsibility when you've got that patient crashing depending on you until the surgeon gets there to fix the problem. I'm only a bandaid in the interim, but if I don't respond appropriately, aggresively, and in an emergent manner, it won't matter because the patient will die before the surgeon gets there.

.

only someone with a medical education can realize how foolish the above post is.. I will leave it at that..

 

[BlackScorpion]

I thought this was the ANESTHESIOLOGY FORUM, why the hell are we talking about this?

 

[cfdavid]

I do agree with part of what you are saying in regards to nursing pre reqs. Some of what the nursing degrees require are not rigid courses (nursing theory, research, etc.) However, we also take the same hard sciences, I had anatomy, physiology (1 and 2), micro, chem, pharmacology, and pathophysiology all as undergrad classes. I will extend these further in the graduate portion of my education and take in depth anesthesia specific anatomy and physiology, advanced chem, patho, and pharm. I could take the MCAT now with my 2 undergrad degrees I have if that was my career goal. Don't assume that "nursing" classes just for the sake of being a nursing program don't focus on the sciences. We are just as heavily based in the sciences as the AAs are, and the pre med majors.

As far as ICU experience, the average trend is 2-3 years ICU experience in the usual SRNA class. Years of experience can range from 1 year to over 10 years in any given class. Many are quick to downplay that experience. When that sick septic patient rolls in the door and the intensivist is in route, I'm the one hanging drips, getting labs, and getting the ball rolling before he even gets there without any back up from him. It is imperative that I understand what's going on, what the current recommended treatments are, and how to intervene fast. Granted, he will usually intubate when he gets there and place a line, but I've learned to work with what I've got and keep that patient going until he gets there. Same goes for the bypass patient who is bleeding. I call the surgeon to come in, but the management of that patient is left up to me until he gets there. It's a huge responsibility when you've got that patient crashing depending on you until the surgeon gets there to fix the problem. I'm only a bandaid in the interim, but if I don't respond appropriately, aggresively, and in an emergent manner, it won't matter because the patient will die before the surgeon gets there.

An ICU nurse has a unique experience with crashing patients that lends us to being very well suited to managing patients in the OR. Of course, I realize the extra medical expertise the anesthesiologists bring only complements the experiences I've had in the ICU. That's why I think an ACT works so well. All the members are educated professionals and each bring different advantages to the team that complement and make the group better as a whole.

I can't speak to the experience that AAs bring to the table, and I honestly don't have a formed oppinion of them, quite frankly only because I haven't ever worked with or seen any where I work (Tennessee). I only wanted to clarify and expand on a few things about the nursing component of anesthesia delivery because I am a nurse and do know exactly what background we enter our training with.

Hey man, I realize CRNA's are well trained professionals. It's a minority that tend to trash on the AA's, and that's why I tend to point out some of what I consider strengths of an AA program (not at the expense of a CRNA program).

However, at the 3 major universities in which I've taken courses (one for undergrad, and post baccs courses at two others), the nursing students (all 3 had nursing programs) where never in the bios, chems, organic chems, physics, micros, biochems, and physiologies that the pre-med and science majors were in. Anatomy was the only class where I had a fair number of nursing and PT students in, primarily because it was an elective (even for science majors). And I was probably the minority in anatomy.

I acknowledge that nursing students do study the sciences. But, in my experience they are separate and different courses, and tend to provide a more cursory explanation. And so when I hear the minority of CRNA's or SRNA's champion their system of education/expertise at the expense of an AA, I like to remind them of that. It's stricly reactionary, but does have it's basis in fact.

 

[Noyac]

Hey man, I realize CRNA's are well trained professionals. It's a minority that tend to trash on the AA's, and that's why I tend to point out some of what I consider strengths of an AA program (not at the expense of a CRNA program).

However, at the 3 major universities in which I've taken courses (one for undergrad, and post baccs courses at two others), the nursing students (all 3 had nursing programs) where never in the bios, chems, organic chems, physics, micros, biochems, and physiologies that the pre-med and science majors were in. Anatomy was the only class where I had a fair number of nursing and PT students in, primarily because it was an elective (even for science majors). And I was probably the minority in anatomy.

I acknowledge that nursing students do study the sciences. But, in my experience they are separate and different courses, and tend to provide a more cursory explanation. And so when I hear the minority of CRNA's or SRNA's champion their system of education/expertise at the expense of an AA, I like to remind them of that. It's stricly reactionary, but does have it's basis in fact.

Never met a nursing students in any of my premed courses.

 

[cfdavid]

Never met a nursing students in any of my premed courses.

Me neither. That anatomy class was one in which I was classified as general post-bacc. So, I just dedided to take it in advance of gross anatomy in med school. It wasn't a requirement for any science majors but there were pre-PT students, pre-dental, a few other pre-meds, and maybe a few in the nursing or pre-nursing program (to be honest there may not have been too many now that I really look back). But, never any in the "hard" science courses that we (and all AA's) had to take.

That's simply a fact. So is the MCAT for most pre-AA's. Just as it's a fact that AA's don't have a minimum of 1 year ICU as a pre-req to enter into an AA program. That's true.

But, I've heard so many threads of either CRNA's or SRNA's bashing on AA programs that I feel it's only fair to point out some "other" differences.

Here's a link to Case's AA program. It shows the pre-req's etc.

http://www.anesthesiaprogram.com/admissions.htm

 

[Noyac]

I thought this was the ANESTHESIOLOGY FORUM, why the hell are we talking about this?

What, does this not pertain to anesthesia?

 

[starsweet]

Ok, thanks for this info. One more thing, are the salaries similar (I heard it was around 160K)?

 

[deltaxi917]

hello everyone,
i was just wondering if anyone was willing to give advice on AA's. I am looking into becoming an AA but i need lots of advice. please let me know if anyone if available to answer any of my questions. thank you

 

[SilverStreak]

So I guess I just made up the fact that I took all these courses and they were required for my nursing degree? Seriously guys I don't want to have a battle of which degree is better. That was not my intent. My only point was that undergrad nursing degrees do require more of the sciences than some of you might think.

And, in reply to making medical decisions, no I realize I do not order anything in the ICU. I do however have a lot of freedom to follow protocols (yes, designed usually by MDs), but I still have to know how and when to implement them. And, our intensivists respect our contributions enough to the team that they are very positive in letting us know we do a good job at what we do. What my previous post was making reference to in the ICU is that as an ICU nurse, I get a lot of experience with making swift necessary decisions that require my professional judgement to make a good decision.

I have control of the heart when it rolls into the ICU, and to a large extent, I control what happens on the monitor with my hands-by my titration of vasoactive gtts, use or not of a temporary pacer, knowing when to give fluids, giving a calcium bolus when appropriate. Some of you may scorn the knowledge we have, but I don't think some of you have an idea of the true nature of the experiences we have. I think all of this is part of what makes the ICU experience valauble when we start anesthesia school.

 

[SilverStreak]

Hey man, I realize CRNA's are well trained professionals. It's a minority that tend to trash on the AA's, and that's why I tend to point out some of what I consider strengths of an AA program (not at the expense of a CRNA program).

However, at the 3 major universities in which I've taken courses (one for undergrad, and post baccs courses at two others), the nursing students (all 3 had nursing programs) where never in the bios, chems, organic chems, physics, micros, biochems, and physiologies that the pre-med and science majors were in. Anatomy was the only class where I had a fair number of nursing and PT students in, primarily because it was an elective (even for science majors). And I was probably the minority in anatomy.

I acknowledge that nursing students do study the sciences. But, in my experience they are separate and different courses, and tend to provide a more cursory explanation. And so when I hear the minority of CRNA's or SRNA's champion their system of education/expertise at the expense of an AA, I like to remind them of that. It's stricly reactionary, but does have it's basis in fact.

I had a genius in my nursing class. He originally wanted to go to med school, but he had a major stress disorder and would get sick before every class. Anyway, he considered taking a few extra classes and he could have gotten a triple major--in nursing, chemistry, and biology. I was originally a bio major myself when I was stradling the fence about going to med school. So, in short I may have a few more science courses than the average nursing major, but if my friend up above could get a degree in both chem and bio with only adding a little more to his course work, hopefully you'll see my point that we do take sciences. Also, probably half the science courses you'll take will have pre med majors in them. Doesn't mean squat as you know until you actually get into med school. So why would nursing majors not be as qualified to take "premed" sciences? There's no distinction when I register for my classes "oh I can't take that one--it's premed bio". Some of you guys may also be confusing an associates RN program with a bachelors RN program. But, then again, maybe not, some of you just find fault with anything remotely connected to nursing. Again, I do not want to fight about degree programs, and who has a better education. I realize now I am wasting my time posting this at all. I simply wanted to clarify a few things about nursing education.

 

[SilverStreak]

a year in the icu as a nurse is nothing... if you are not making decisions.. (medical decisions)..

I have no use for your oppinions. You have demonstrated repeatedly your contempt for nursing. I am glad I know the inherent value and dignity I carry with my profession and do not need to answer to some of the ridiculously insulting comments you make about nurses. One day, you'll depend on a nurse, I hope on that day, you'll keep your mouth shut.

 

[Tenesma]

silverstreak.... i hate to say this, but following protocols and algorithms is just that ... it isn't anything more than that.... there is no independence just because you are left alone with the patient...

examples?
1) Pt is bleeding - the physician decides if the pt needs to go to the OR, the physician decides whether to order coags and whether to transfuse... you hang the bag and draw the labs (after they are ordered)

2) the CABG patient's CO is dropping - the physician decides to increase the rate on the pacemaker... you dial it in (after it is ordered)

3) the potassium is low - the physicians have established a preset protocol for you to administier potassium... you hang the bag


don't be fooled into thinking that titrating drips within preset parameters means anything...

 

[Tenesma]

haven't worked w/ AAs so I have nothing to say about AAs... I have worked w/ tons of CRNAs, and found it (most of the time) to be a pleasant experience

 

[SilverStreak]

silverstreak.... i hate to say this, but following protocols and algorithms is just that ... it isn't anything more than that.... there is no independence just because you are left alone with the patient...

examples?
1) Pt is bleeding - the physician decides if the pt needs to go to the OR, the physician decides whether to order coags and whether to transfuse... you hang the bag and draw the labs (after they are ordered)

2) the CABG patient's CO is dropping - the physician decides to increase the rate on the pacemaker... you dial it in (after it is ordered)

3) the potassium is low - the physicians have established a preset protocol for you to administier potassium... you hang the bag


don't be fooled into thinking that titrating drips within preset parameters means anything...

I freely agree that we follow protocols, but your above assumptions are not correct. When I have a patient bleeding, I order any labs I think I need, go ahead and call the blood bank for blood and get it going, while someone else is calling him, if I've left anything out, then he'll order it as well, but usually I've got it all covered. If my patients CO is dropping, I decide whether to use the pacer and what rate to set it at, it doesn't have to be ordered. Or, I decide if the CO is falling because my SVR is rising- is the patient cold, do they need fluid? I decide and intervene accordingly. I do have a preset order to maintain my K at 4.2, but the protocol doesn't tell me how much to give, just to keep my K up. I decide, based on the patients renal status, UOP, if I'nm going to give lasix to diurese how much to give, the exact amount is not ordered. And, titrating gtts within preset parameters DOES mean something. I'm at the beside watching my numbers, learning how the drugs work, what the halflife is, deciding which drug to use, ie at what point do I switch from nitro to cardene, and what is my reasoning/goal to accomplish by doing this? I don't have to call anybody for an order before making these decisions. We have a lot more independence that any of you may think.

The catch is, a good ICU nurse knows the boundaries. Up to a point, I will do everything available to me to optimize the bypass patient, but I know that point when I need to call and say I've done this, this, and this, and it's not working, what am I missing, or what do you want done next? My pride in my training never gets in the way of me realizing it is time for me to call the MD and let him tell me what to do. Then, I'll get an order for something else, or he'll tell me he did a lot of TMR on the patient, so he expects a sluggish myocardium-these are the types of things I don't always know and I'm learning. All I'm saying is give the nurses some credit. Not all of us are dummies who blindly follow a preset program and don't know what we're doing or why.

 

[Noyac]

I had a genius in my nursing class. He originally wanted to go to med school, but he had a major stress disorder and would get sick before every class. Anyway, he considered taking a few extra classes and he could have gotten a triple major--in nursing, chemistry, and biology. I was originally a bio major myself when I was stradling the fence about going to med school. So, in short I may have a few more science courses than the average nursing major, but if my friend up above could get a degree in both chem and bio with only adding a little more to his course work, hopefully you'll see my point that we do take sciences. Also, probably half the science courses you'll take will have pre med majors in them. Doesn't mean squat as you know until you actually get into med school. So why would nursing majors not be as qualified to take "premed" sciences? There's no distinction when I register for my classes "oh I can't take that one--it's premed bio". Some of you guys may also be confusing an associates RN program with a bachelors RN program. But, then again, maybe not, some of you just find fault with anything remotely connected to nursing. Again, I do not want to fight about degree programs, and who has a better education. I realize now I am wasting my time posting this at all. I simply wanted to clarify a few things about nursing education.

I didn't say that the nursing students were not qualified to take these courses. Just that I never saw them in these courses. I personally don't see any problem with them taking these courses.

 

[militarymd]

silverstreak.... i hate to say this, but following protocols and algorithms is just that ... it isn't anything more than that.... there is no independence just because you are left alone with the patient...

examples?
1) Pt is bleeding - the physician decides if the pt needs to go to the OR, the physician decides whether to order coags and whether to transfuse... you hang the bag and draw the labs (after they are ordered)

2) the CABG patient's CO is dropping - the physician decides to increase the rate on the pacemaker... you dial it in (after it is ordered)

3) the potassium is low - the physicians have established a preset protocol for you to administier potassium... you hang the bag


don't be fooled into thinking that titrating drips within preset parameters means anything...

When I attended in the ICU, I will listen to the residents present the patients, and then listen to their assessment and plan.

AFTER, the rounds were over, when I'm seeing the patients myself and writing my notes, I will generally listen to what the ICU nurses will have to say (at least the experienced ones).....

Take it anyway you want, but I would trust my life with the experienced ICU nurse over the junior resident more often than not.

 

[Tenesma]

militarymd... i hear you - i have known some experienced nurses as well. Comparing an experienced nurse to a junior resident is an unfair comparison on many levels...

silverstreak... what you are doing is BATTERY and practicing MEDICINE. It is not within the scope of nursing to decide whether a patient needs to be transfused, it is not within the scope of nursing to decide between diuresis or not to diurese, it is not within the scope of nursing to decide on a dose of Potassium to be administered. Your ICU should have clear parameters and protocols that you abide by, and if it doesn't and you are given carte-blanche in your care of the patient then the ICU should be shut down by JACHO and you should be held accountable both in a criminal and a civil court.

 

[cfdavid]

I had a genius in my nursing class. He originally wanted to go to med school, but he had a major stress disorder and would get sick before every class. Anyway, he considered taking a few extra classes and he could have gotten a triple major--in nursing, chemistry, and biology. I was originally a bio major myself when I was stradling the fence about going to med school. So, in short I may have a few more science courses than the average nursing major, but if my friend up above could get a degree in both chem and bio with only adding a little more to his course work, hopefully you'll see my point that we do take sciences. Also, probably half the science courses you'll take will have pre med majors in them. Doesn't mean squat as you know until you actually get into med school. So why would nursing majors not be as qualified to take "premed" sciences? There's no distinction when I register for my classes "oh I can't take that one--it's premed bio". Some of you guys may also be confusing an associates RN program with a bachelors RN program. But, then again, maybe not, some of you just find fault with anything remotely connected to nursing. Again, I do not want to fight about degree programs, and who has a better education. I realize now I am wasting my time posting this at all. I simply wanted to clarify a few things about nursing education.

I don't know.. Like Noyac, my experiences have been that nursing students take other classes. I'm sure they're science courses, and called by the same "names". But, out of the three universities I have experience with, there was more of a distinction between the sciences that the nurses took, and those that science majors and other pre-meds took (and pre-AA). In fact, in most of those BSRN programs, ONLY nurses could enroll in them.
With the exception that as a "post-bacc" designee at one university, I had a lot more flexibility in terms of taking pretty much any course I wanted.

I had originally enrolled in Microbiology XXX, to find out that most of the class were nursing or pre-nursing (naturally, since it was "required of all students in the nursing program). Well, I sat through a few weeks in lecture and was disapointed with the cursory manner of material coverage. So, I dropped and to Microbiology XXX (had a lab and originally didn't want to put that much time in), which was the one "required of students in the biological sciences department", and that class was filled, naturally, with science majors and pre-professional majors. And it went into much more depth based on my experience.

 

[cfdavid]

hello everyone,
i was just wondering if anyone was willing to give advice on AA's. I am looking into becoming an AA but i need lots of advice. please let me know if anyone if available to answer any of my questions. thank you

Call down to Case's program. Ask to speak with someone. There's a woman named "Chris" who's like an admissions advisor. She's very nice. You can set up a day to shadow an AA and MD as well as to speak with the program director. They're great people, and I was very impressed with the program and people in it. I was also impressed with the degree of pre-requisites required (I posted the link in another thread on this post).

If Case isn't close, try one of the others that may be closer. I loved shadowing in the OR and it really spurred an interest in anesthesiology (I'm going the doctor route and decided against the AA route, but not due to anything negative about the AA program itself).

Oh, and I was shadowing an experienced AA who (along with the MD) was teaching the 2nd year AA student. The student already had a job offer lined up with great pay (didn't really ask, but I think around 120 or 125 to start). Not bad....

 

[militarymd]

militarymd... i hear you - i have known some experienced nurses as well. Comparing an experienced nurse to a junior resident is an unfair comparison on many levels...

silverstreak... what you are doing is BATTERY and practicing MEDICINE. It is not within the scope of nursing to decide whether a patient needs to be transfused, it is not within the scope of nursing to decide between diuresis or not to diurese, it is not within the scope of nursing to decide on a dose of Potassium to be administered. Your ICU should have clear parameters and protocols that you abide by, and if it doesn't and you are given carte-blanche in your care of the patient then the ICU should be shut down by JACHO and you should be held accountable both in a criminal and a civil court.

You are correct, the scope of practice of a nurse and physician are different.......but that doesn't mean that a nurse 1) doesn't know what's going on...or 2) has no judgement....

They will frequently and hopefully have both 1 and 2....however, those decisions you talk about are the responsibilities of the attending physician.

 

[stephend7799]

but I would trust my life with the experienced ICU nurse over the junior resident more often than not.

I absolutely wouldn't.

 

[stephend7799]

militarymd... i hear you - i have known some experienced nurses as well. Comparing an experienced nurse to a junior resident is an unfair comparison on many levels...

silverstreak... what you are doing is BATTERY and practicing MEDICINE. It is not within the scope of nursing to decide whether a patient needs to be transfused, it is not within the scope of nursing to decide between diuresis or not to diurese, it is not within the scope of nursing to decide on a dose of Potassium to be administered. Your ICU should have clear parameters and protocols that you abide by, and if it doesn't and you are given carte-blanche in your care of the patient then the ICU should be shut down by JACHO and you should be held accountable both in a criminal and a civil court.

I completely agree with you tenesma..

I wonder who is paying silverstreaks malpractice with his, " I dont need a doctor to tell me when the svr is too high and when I need to augment the CO. The job of a nurse is just that. and inform the doctor of whats going on and it is up to him/her to make a decision . you must have a physicians order to do EVERYTHING.. you may agree or disagree all you want but you are a NURSE trying to practice medicine.. The lawyers will have a field day on you. YOU DO NOT KNOW ENOUGH TO MAKE INDEPENDENT DECISIONS. PERIOD. and the fact that you think you do scares me

 

[jetproppilot]

I absolutely wouldn't.

this conversation shows that the longer you are in this business the more you appreciate other professional's expertise and are less threatened by their prowess.

 

[militarymd]

Take it anyway you want, but I would trust my life with the experienced ICU nurse over the junior resident more often than not.

I absolutely wouldn't.

Let me guess who you would trust.....This guy












































The internet sex booster guy...right?

 

[jwk]

hello everyone,
i was just wondering if anyone was willing to give advice on AA's. I am looking into becoming an AA but i need lots of advice. please let me know if anyone if available to answer any of my questions. thank you

Rather than take up forum space, PM me - I can answer all your AA questions since I've been an AA for 25+ years.

 

[SilverStreak]

I completely agree with you tenesma..

I wonder who is paying silverstreaks malpractice with his, " I dont need a doctor to tell me when the svr is too high and when I need to augment the CO. The job of a nurse is just that. and inform the doctor of whats going on and it is up to him/her to make a decision . you must have a physicians order to do EVERYTHING.. you may agree or disagree all you want but you are a NURSE trying to practice medicine.. The lawyers will have a field day on you. YOU DO NOT KNOW ENOUGH TO MAKE INDEPENDENT DECISIONS. PERIOD. and the fact that you think you do scares me

Nothing I say is going to change your mind. But, I will defend myself against some of how what I have said is being interpreted. First of all, in the case of transfusing blood, I had a patient one night come over from the OR and immediately dump a huge amount out of his chest tube. This surgeon is well known for his patients not putting out much from the chest tube. We are getting stat labs and calling blood bank to tell them we need blood stat. Whole time, patient continues to bleed, bp is plummeting, neo not holding my pressure. What does he need? VOLUME! And, to correct the source of the bleeding so he will not continue to lose volume at an alarming rate. I have the surgeon on the phone within 5 minutes telling him this is what is going on. He EXPECTS I have already ordered the blood and it is on its way.

As far as knowing when to augment my CO and how, and when to decide my SVR is too high and needs to be treated. I know the principles of hemodynamics in recovering a heart, and what I am covered to do in my unit. It is always CYA, no doubt. But, I realize if I have a brady pt with a crappy bp, oh yeah maybe i should trying pacing since CO = HR x SV, hence pacer will increase my HR and increase my CO ( I am covered under my orderset to start pacer for symptomatic bradycardia, well hypotension, low UOP, and crappy CI are certainly symptomatic enough for our docs). I also realize if I have a cold patient come over from the OR with a temp of 95 and an SVR of 1800 I need to warm and vasodilate so the heart can pump against less resistance. Once I've done that and given some needed volume, I may be on some nitroglycerine later for bp control. Huh, my CVP won't stay up even though I'm giving volume and patient is not peeing that much. Maybe it is because my nitro is primarily a venous dilator contributing to my decrease in preload, so I can go to cardene, which will help control my bp without knocking out my CVP since it is an arterial dilator, help decrease my SVR and thereby increase my CO. Cardene is on my order set, so I can decide to start it if I need to, and I'm covered to do so.

And, on my standing orders, my orders read to maintain K at 4.2. Period. That's it. It's left to my discretion to decide how much to give based on how I'm managing my patient. I do have protocols to give lasix, but again, it's my discretion based on those parameters, I can but I don't have to, depends on what my assessment of the patients hemodynamics tell me.

Nothing I have posted above I am not covered to do. NOTHING. We even get a verbal for standing orders to transfuse blood, but one surgeon will tell us look at the Hgb, if he's hanging at 9.5 and needs volume, you can give the blood, or if he's stable a 9.0 and looks good, you can hold the blood. I decide. Yes, if I'm unsure I'll always call without hesitation. I am not advocating nurses who do things without an order or protocols in place. But, like it or not , believe me or not, in my unit I do not have to call to place a post op heart on a pacer when needed, call hanging drugs to reduce my afterload, give volume to help the heart contract better, give calcium, give K, or any other number of "orders" you guys think we're too stupid to know the rationale for, it's on my orders, and I decide the management of my patient to a huge degree. Now, as I said in another post, the hallmark of a GOOD ICU nurse knows when I've tried all the things at my disposal and need to let the surgeon decide what comes next. But, if I call my surgeon at 2200 after he's been operating all day tell him "Mr. X's CI = 1.7. His CVP is 4 and his SVR is 1785, oh and his temp is 95.2, what do you want me to do?" I'll get reamed. There are too many problems in the above statement that I can fix before going to him. Now, after I have Mr. X's CVP up to maybe 10, his SVR is 1300, his temp is 97.8, he's paced at a rate of 90, and I still have a CI of 1.8, then I'm calling to say, hey you want some dob?

So, I hope you never come to work at my facility because I make DECISIONS- with guidance from my surgeons order set every day I work, and I am fully and legally covered to do so. You think what you want about ICU nurses and their experiences, but I know my stuff. Don't minimize what I'm capable of just because it takes away some of my dependence on you. I know when I need you, and when I don't. I think it just pisses you off because maybe I can go a whole 12 hours shift without bowing to your throne and asking you the correctness of every singe decision I start to make.

 

[BIS]

Guess it all depends on how good the RN or resident is. If you have a resident Surg or Anesthesia and def. intern that is new to the unit and the critical care arena vs a RN that has worked in that CVICU/Trauma ICU, id go with the RN. Of course the Resident will understand the physiology of issues much better but the RN of 10 years has prob. been in that specific situation hundreds of times. Most of the RN's decisions are based on what MD's have done in that same situation and they have learned over time. Not to mention many of the RN's know what course of action specific surgeons.

Also how long has that Resident worked with that pt population. You have general surgery residents rotating thru CTICU's having not managed that type of pt not to mention numerous devices for a year or more. When they get there they are rusty. Yes they can put in lines great but when you go from managing some not so sick general surg pts to managing a sick as crap open chest cab things change.

The way it is and should be is that we all watch each others back. MD things RN is doing something questionable then he should question it. RN thinks something MD is doing is questionable then they should ask for a rationale.

 

[SilverStreak]

I absolutely wouldn't.

And I can give you the names of 2 surgeons in my area I wouldn't trust to operate on my mom's cat I hate, they are that crappy. But, you know, people trust them everyday with their lives. There's a huge false sense of security in regards to titles, and people equate MD often with God. As I've said before, having the title doesn't necessarily make you good or bad at what you do.

 

[LAZYGUY]

I have never been on this board & was completely taken back by the underlying trend that I see in many posts. With the exception of posters such as Military & Jet, who I completely agree with, many seem unable to appreciate anyone but themselves. A nurse in a post emphasized how nurses make important contributions & then you have 3 or 4 replies downplaying those contributions. Some even gave the ridiculous counter-point of saying that their premed courses are more challenging than the nursing curriculum.

I guess what I am saying is, respect other people. You are going to be or already are physicians. We cannot have the "i am better than you" attitude that we commonly see in the outside world. These are our co-workers, we need them. It is no wonder why we are losing good nurses due to the idiotic attitude of many physicians. The message we should be giving to nurses is that we stand with them. We are not competitors. These are very smart individuals who deserve to be treated as such.

Stop being asses and treat people well. Don't hang your self-worth on being a physician. The truth is, nobody really cares and in the end people will remember you more for your kindness than for your accomplishments.

 

[MacGyver]

To all the docs stating that experienced nurses are better than inexperienced residents:



If experienced nurses are better than inexperienced residents, then we should just disband medical schools and replace it with clinical "on the job" training.

 

[Cap'nOblivious]

To all the docs stating that experienced nurses are better than inexperienced residents:

They didn't state that. You're twisting the whole point around.

If experienced nurses are better than inexperienced residents, then we should just disband medical schools and replace it with clinical "on the job" training.

No one thinks this. Some bitter nurses might say it, but deep down they recognize the knowledge gap.

 

[VA Hopeful Dr]

To all the docs stating that experienced nurses are better than inexperienced residents:



If experienced nurses are better than inexperienced residents, then we should just disband medical schools and replace it with clinical "on the job" training.

The experienced nurses have completed their training and been at their jobs for some time. The inexperienced residents have done neither. When the residents are done (ie. are attendings) I would tend to think they have more knowledge than said nurses about all manner of medicine.

PS. You are a tool.

 

[Heme/Onc]

I will soon be starting my intern year and frankly I am scared as hell. Moreover, I will be starting in the ICU so I am being thrown into the fire....so to speak. I agree with Millitary that a seasoned nurse in the ICU has alot to contribute and knows a hell (and I mean a hell) of alot more than I do when working in the ICU. However, that does not mean that I will not think on my own at every step of the way (no matter who I am dealing with). I also think that the understanding of physiology/biochemistry/pharmacology of a resident is greater than the average RN (but experience is experience).

But, I think a seasoned Intensivist is no comparison to a seasoned ICU nurse. The same is true for a SEASONED crna VS seasoned Anesthesiologist, or FP vs NP in primary care. Basically, I feel that experience means alot but the learning curve is steep especially when you are grounded in the correct sciences. Anyway, just my opinion....

 

[stephend7799]

Nothing I say is going to change your mind. But, I will defend myself against some of how what I have said is being interpreted. First of all, in the case of transfusing blood, I had a patient one night come over from the OR and immediately dump a huge amount out of his chest tube. This surgeon is well known for his patients not putting out much from the chest tube. We are getting stat labs and calling blood bank to tell them we need blood stat. Whole time, patient continues to bleed, bp is plummeting, neo not holding my pressure. What does he need? VOLUME! And, to correct the source of the bleeding so he will not continue to lose volume at an alarming rate. I have the surgeon on the phone within 5 minutes telling him this is what is going on. He EXPECTS I have already ordered the blood and it is on its way.

As far as knowing when to augment my CO and how, and when to decide my SVR is too high and needs to be treated. I know the principles of hemodynamics in recovering a heart, and what I am covered to do in my unit. It is always CYA, no doubt. But, I realize if I have a brady pt with a crappy bp, oh yeah maybe i should trying pacing since CO = HR x SV, hence pacer will increase my HR and increase my CO ( I am covered under my orderset to start pacer for symptomatic bradycardia, well hypotension, low UOP, and crappy CI are certainly symptomatic enough for our docs). I also realize if I have a cold patient come over from the OR with a temp of 95 and an SVR of 1800 I need to warm and vasodilate so the heart can pump against less resistance. Once I've done that and given some needed volume, I may be on some nitroglycerine later for bp control. Huh, my CVP won't stay up even though I'm giving volume and patient is not peeing that much. Maybe it is because my nitro is primarily a venous dilator contributing to my decrease in preload, so I can go to cardene, which will help control my bp without knocking out my CVP since it is an arterial dilator, help decrease my SVR and thereby increase my CO. Cardene is on my order set, so I can decide to start it if I need to, and I'm covered to do so.

And, on my standing orders, my orders read to maintain K at 4.2. Period. That's it. It's left to my discretion to decide how much to give based on how I'm managing my patient. I do have protocols to give lasix, but again, it's my discretion based on those parameters, I can but I don't have to, depends on what my assessment of the patients hemodynamics tell me.

Nothing I have posted above I am not covered to do. NOTHING. We even get a verbal for standing orders to transfuse blood, but one surgeon will tell us look at the Hgb, if he's hanging at 9.5 and needs volume, you can give the blood, or if he's stable a 9.0 and looks good, you can hold the blood. I decide. Yes, if I'm unsure I'll always call without hesitation. I am not advocating nurses who do things without an order or protocols in place. But, like it or not , believe me or not, in my unit I do not have to call to place a post op heart on a pacer when needed, call hanging drugs to reduce my afterload, give volume to help the heart contract better, give calcium, give K, or any other number of "orders" you guys think we're too stupid to know the rationale for, it's on my orders, and I decide the management of my patient to a huge degree. Now, as I said in another post, the hallmark of a GOOD ICU nurse knows when I've tried all the things at my disposal and need to let the surgeon decide what comes next. But, if I call my surgeon at 2200 after he's been operating all day tell him "Mr. X's CI = 1.7. His CVP is 4 and his SVR is 1785, oh and his temp is 95.2, what do you want me to do?" I'll get reamed. There are too many problems in the above statement that I can fix before going to him. Now, after I have Mr. X's CVP up to maybe 10, his SVR is 1300, his temp is 97.8, he's paced at a rate of 90, and I still have a CI of 1.8, then I'm calling to say, hey you want some dob?

So, I hope you never come to work at my facility because I make DECISIONS- with guidance from my surgeons order set every day I work, and I am fully and legally covered to do so. You think what you want about ICU nurses and their experiences, but I know my stuff. Don't minimize what I'm capable of just because it takes away some of my dependence on you. I know when I need you, and when I don't. I think it just pisses you off because maybe I can go a whole 12 hours shift without bowing to your throne and asking you the correctness of every singe decision I start to make.

all im saying is i hope the hospital carries some serious malpractice insurance.. there should be no standing orders for decreasing uop, or decreasing CO.. NONE.. or transufisng blood for that matter.. thats just craziness.

 

[SilverStreak]

But, I think a seasoned Intensivist is no comparison to a seasoned ICU nurse. ....

You will hear no argument at all from me on this point. We love our intensivist and he is absolutely one of the top 10 smartest guys on the planet. He can pull stuff out of his head that most people can't begin to start processing, and he can lay it out for you in succinct detail. Unfortanately, I don't see him as much on night shift since he has a partner now and they split call.

One of the things most valuable to me about having him on our team is what an amazing teacher he is. He actually teaches a mini course to our nurses accepted into anesthesia school the summer before they leave. I have no greater respect for any physicians bedside manner and knowledge than I do his, and the fact that he freely shares his knowledge with others. He's the one when you've got a really bad patient, the first question you want to know in report is if he is on the case. Question two is always will the attending consult him so he can contribute to the case.

 

[SilverStreak]

all im saying is i hope the hospital carries some serious malpractice insurance.. there should be no standing orders for decreasing uop, or decreasing CO.. NONE.. or transufisng blood for that matter.. thats just craziness.

You must not have been around post op hearts to make such bland statements. Only in our hearts do we have this type of autonomy, and only after months and months of rigorous training. If we didn't have good protocols, we would drive the surgeons crazy calling them constantly because a fresh heart is often labile in terms of hemodynamic status. I am fully confident in what I'm allowed to do. Our typical standing order from the surgeon is Keep CI > 2.2, or whatever number they deem acceptable for the patient, and usually keep hct > 28. Just so you know, our ICUs were recognized as one of the top in the state and our heart program was in the top 100 cardiovascular hospitals nationwide, so we must be doing something right.

How far along in your training are you? Even on other surgical post op orders, surgeons write standing orders for if UOP if < a set number what we can do, then if UOP still not acceptable call for further orders. I take care of a surgeons patients who routinely will consult our intensivist for decreased UOP post op if 25 of SPA and 20 of lasix don't work, he hits a road block and doesn't know what else to do. Cut the crap that just because you're a doctor you have all the answers, and just because I'm a nurse I don't have any.

 

[militarymd]

all im saying is i hope the hospital carries some serious malpractice insurance.. there should be no standing orders for decreasing uop, or decreasing CO.. NONE.. or transufisng blood for that matter.. thats just craziness.

I wonder if Dr. Ray carries serious malpractice insurance for his internet sex boosters.

 

[BIS]

all im saying is i hope the hospital carries some serious malpractice insurance.. there should be no standing orders for decreasing uop, or decreasing CO.. NONE.. or transufisng blood for that matter.. thats just craziness.

Your inexperience is always shinning bright. Protocols are what keeps most of the descision making in the MD's power , being the MD wrote them. They guide most descisions including those of RN's, Resp. Therapy, MD's, Pharm ect.

For instance on a busy sunday in a large CTICU, census 41 pts, and one intensivist anesthesiologist in house. Does that MD have time to answere every page and see every pt that has electrolyte abnormalities. Is it safe that the intensivist make all descisions what so ever, or make risky descisions via phone calls about pts they havent even assessed. Should a RN call that intensivist for every inotrope or pressor titration issue?

Should the RN call the nephrologist everytime they need to make changes on CVVHD UF rates b/c the pt cant handle it? Should they have to call and ask to give CaCl when we all know the citrate in the ACD is going to decrease the Ca. You continue to be a joke . Of course everyone needs to realize their limitations but MD's have limitations as well. IT is unsafe for the MD to be managing 41 ICU pts and making every descision possible. That MD would be exhausted. Protocols as such can guide an ICU Nurse. The ICU RN can be thinking somewhat along the line of interventions the intensivist would be leaning toward since that intensivist has developed the protocol.

Guess RN's shouldnt be allowed to follow ACLS protocols and make drug, and resuscitation decisions? We will be sure to tell your family member that when no MD is in house. Of we couldnt sanve them, there was no md around and RN's here cant follow protocols. The American Hrt Assoc, American acad. of Pedi, American Acad. of Cardiology all disagree as well as many of your associates here. Maybe you will understand when you actually make a decision, one that is not via paper and pencil on a test. Hopefully you will grow up thru the course of your residency. You need it man.

 

[stephend7799]

You must not have been around post op hearts to make such bland statements. Only in our hearts do we have this type of autonomy, and only after months and months of rigorous training. If we didn't have good protocols, we would drive the surgeons crazy calling them constantly because a fresh heart is often labile in terms of hemodynamic status. I am fully confident in what I'm allowed to do. Our typical standing order from the surgeon is Keep CI > 2.2, or whatever number they deem acceptable for the patient, and usually keep hct > 28. Just so you know, our ICUs were recognized as one of the top in the state and our heart program was in the top 100 cardiovascular hospitals nationwide, so we must be doing something right.

How far along in your training are you? Even on other surgical post op orders, surgeons write standing orders for if UOP if < a set number what we can do, then if UOP still not acceptable call for further orders. I take care of a surgeons patients who routinely will consult our intensivist for decreased UOP post op if 25 of SPA and 20 of lasix don't work, he hits a road block and doesn't know what else to do. Cut the crap that just because you're a doctor you have all the answers, and just because I'm a nurse I don't have any.

I am not saying you dont know what you are doing or you dont know what to do in a certain situation or you cannot diagnose the cause for decreasing
uop.. maybe the housekeeper can do it.. But it is the physicians job to do it.. Why would you wanna do a physicians job?? If you wanna do a physicians job go to physician school. you are there to take orders not to think for yourself .. i hate to say it.. but thats how it works.. just like in the military.. the officers give orders and the enlisted men take orders.. It cannot be the other way around.. the system breaks down if the reverse is true

 

[BIS]

I am not saying you dont know what you are doing or you dont know what to do in a certain situation or you cannot diagnose the cause for decreasing
uop.. maybe the housekeeper can do it.. But it is the physicians job to do it.. Why would you wanna do a physicians job?? If you wanna do a physicians job go to physician school. you are there to take orders not to think for yourself .. i hate to say it.. but thats how it works.. just like in the military.. the officers give orders and the enlisted men take orders.. It cannot be the other way around.. the system breaks down if the reverse is true

Obviously you didnt have to take any type of professionalism course in med school. Stenphend you will be a in world of hurt if you enter the clinical arena with the piss poor attitude small mans syndrome that you have. There is no cure man so just accept it. THe Circulators and anesthesia techs will bend you over and stick a carlins DL ETT deep in your anal orfice man. You only have as much power as you do leadership as a trainee whether Resident of SRNA. Especially a new trainee. Being cool to all staff is the key to not only earning and recruiting the support of everyone in the entire dept but will also one day save your assszzsss when you get in a bind and those "people there to take orders" bail you out and make your life easier man. Im counting down the days until someone puts you in your place and you are on this very forum crying and whining b/c a Circulator of PACU RN made you look stupid in front of all your attendings. Remember stephend you big order barker what comes around goes around. The way you are treated by staff only reflects the way you treat them. Your residency will be way more difficult having enemies in the OR. You will be one of the one that will just have to learn the hard way. What a puuussssyyy.

 

[SilverStreak]

I am not saying you dont know what you are doing or you dont know what to do in a certain situation or you cannot diagnose the cause for decreasing
uop.. maybe the housekeeper can do it.. But it is the physicians job to do it.. Why would you wanna do a physicians job?? If you wanna do a physicians job go to physician school. you are there to take orders not to think for yourself .. i hate to say it.. but thats how it works.. just like in the military.. the officers give orders and the enlisted men take orders.. It cannot be the other way around.. the system breaks down if the reverse is true

Your comments would be beyond insulting if it wasn't obvious to me that you have no freaking clue what you're spouting off about. I wish now I did work with you, since I can't think for myself. I can only imagine the inventive calls we'd come up with for you. Let me ask you a question, if I am only there to take orders, and I don't think for myself, then when do I come up with the idea to call you to get orders. If I can't think for myself, then it doesn't bother me that my patient is bradycardiac and hypotensive, because I only follow orders, but oh I don't have any orders for that, so it must not be important. Afterall, since I can't think for myself, why would I consider this change in my patient significant? I should just wait until you round in the morning, and let you see how pretty I wrote down all my vital signs on my flowsheet. I had plenty of time to have neat nurses notes because all I do is write the numbers down, I don't know what they mean, and I don't have to , because thinking is not part of my job. I mean, my god how did I pass state boards, surely somewhere I had to think about something right? Oh, I remember I just learned all that stuff in nursing school to pass boards, because when I graduate and start working, I don't need to think anymore, that's what you're for, right? You do all the thinking for me. And, take all the cracks you want at the housekeeper, but their job is just as important as yours and mine buddy. I hope next time there is a C Diff patient you round on, someone alerts housekeeping so that they can make sure to half a** clean it and you'll catch it. It's probably the only way you won't be full of sh** anymore.