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AA vs. CRNA

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BIS

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stephend7799 said:
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


I guess the marines are calling their superior and saying there are 10 terrorists here planting a road side bomb should we engage them or blow them. Come on. Yes the superior says Private Stephend patrol this area after you clean the head. But private stephend makes the descision to pull the trigger. The superior is not dictating where the private step and not step. It is the privates descision to step or not to step where he might think an IED is planted. And guess what, the military uses protocols too. You should watch bagdad ER on HBO. Nice documentary.

Yes there is many times a chain of command in many professions, but within your limitations are decisions that you must make. This is no different than your attending giving you orders. It is no different than the CEO of the hospital or president of your College of Medicine giving your attending orders and no different than the hospitals or college of medicines board of directors telling the president or CEO what they want. All of these have orders/protocols/goals or plans to follow, though all can make decisions relevant to their position. Grow up man, you make anesthesia residents look bad. Expand your mind, this nation didnt become as productive as is from one guy at the top calling all the shots. Hopefully you will at least hit puberty before your residency is over.
 

jetproppilot

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BIS said:
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. :thumbdown:

nitecap
 

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To others reading my above post, please excuse my ugly behavior, but I feel it is warranted in the above posters (stephend7799) case. I apologize to anyone I unintentionally offend by reading it. It is not directed at any other physician, and was offered in response to the dimwit idea that nurses don't think for themselves. While I enjoy a thoughtful well argued debate, putting down the jobs of others (housekeeping, nursing, CNAs, scrub techs, anyone) is not necessary, so I reacted in a similar mean spirited way. However, mean or not, I say what I mean and I do stand by my comments to him. Again, sorry to any of you who read my post and get offended.
 

stephend7799

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BIS said:
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. :thumbdown:

umm hey nitecap.. go back to all nurses.. Im an attending..
 

SilverStreak

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jetproppilot said:

You guys ever gonna let it go? :D He got what he wanted, he's still under everyone's skin on this board. It's only fun to someone like him when he gets you all riled up again and again.
 

jetproppilot

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SilverStreak said:
You guys ever gonna let it go? :D He got what he wanted, he's still under everyone's skin on this board. It's only fun to someone like him when he gets you all riled up again and again.

wow! you're right. writing in one word, nitecap, in this funny little script is getting all riled up. Sorry. I'll try and compose myself.
 

BIS

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SilverStreak said:
You guys ever gonna let it go? :D He got what he wanted, he's still under everyone's skin on this board. It's only fun to someone like him when he gets you all riled up again and again.

I am not nightcap so get over it. Its impressive that his name lives on like it does. maybe we should chip in a build a memorial. I am far less aurgumentative and have never once had it out with anyone here.

Nothing funny here brown noser, new name = BrownStreak. Now thats funny. I was backing you, you dork and also adding to your aurgument. I addressed stephends inacurrate posts which you called out as well. I rebuked his military comparision and called to question his way of thinking while relating it to real life experience and observation of ICU MD/RN collaboration. Yes I took a few shots at militant stephend but he has been flaming at the mouth for the last few days. The shots were deserved.He is a big boy and im sure can take it.

Why the double standards? if a poster here gets me "riled" up, as happended tonight, believe me you will know it. If it gets them riled up so be it they can go off also. Its typical as soon as someone states an unpopular view here that person is militant and stirring the pot. 1st class private stephend can take all the shots he wants and its gravy. Toughen up Silver. if you want to go to med school please go. You bring good debate to the table but when dealing with those infected with small mans syndrome sometimes you have to give them a taste of their own medicine.

JPP not sure why you are getting riled up. I have not directed one negative comment toward you or your profession. :confused:
 

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jetproppilot said:
wow! you're right. writing in one word, nitecap, in this funny little script is getting all riled up. Sorry. I'll try and compose myself.

I think the small font just proves that you've had problems with little people before and are still harboring resentment. Let it go, Jet.
 

SilverStreak

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BIS said:
I am not nightcap so get over it. Its impressive that his name lives on like it does. maybe we should chip in a build a memorial. I am far less aurgumentative and have never once had it out with anyone here.

Nothing funny here brown noser, new name = BrownStreak. Now thats funny. I was backing you, you dork and also adding to your aurgument. I addressed stephends inacurrate posts which you called out as well. I rebuked his military comparision and called to question his way of thinking while relating it to real life experience and observation of ICU MD/RN collaboration. Yes I took a few shots at militant stephend but he has been flaming at the mouth for the last few days. The shots were deserved.He is a big boy and im sure can take it.

Why the double standards? if a poster here gets me "riled" up, as happended tonight, believe me you will know it. If it gets them riled up so be it they can go off also. Its typical as soon as someone states an unpopular view here that person is militant and stirring the pot. 1st class private stephend can take all the shots he wants and its gravy. Toughen up Silver. if you want to go to med school please go. You bring good debate to the table but when dealing with those infected with small mans syndrome sometimes you have to give them a taste of their own medicine.

JPP not sure why you are getting riled up. I have not directed one negative comment toward you or your profession. :confused:

I was not insulting you by my posting in response to someone calling you nitecap. I just think it's funny that we keep hearing the name come up every time there is a post like this where issues are being discussed that not everyone may agree with. I was trying to point it out in a lighthearted way. Now, I've pissed you and jet off, so next time I guess I'll need to be more direct.

I'm not a brown noser, but we are on their forum and I have enough tact to realize my comments to stephen7799 were rude, and that others may take offense and think I secretly feel that way about all physicians. That is why I apologized to others who may read the comment, however, also note that I said I stand by what I posted, and I meant it.

Thanks for your support. You also make some good arguments in support of nursing. Sadly, I think it often falls on deaf ears for those who do not understand all the parts everyone plays in the care of patients.
 

jetproppilot

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BIS said:
I am not nightcap so get over it. Its impressive that his name lives on like it does. maybe we should chip in a build a memorial. I am far less aurgumentative and have never once had it out with anyone here.

Nothing funny here brown noser, new name = BrownStreak. Now thats funny. I was backing you, you dork and also adding to your aurgument. I addressed stephends inacurrate posts which you called out as well. I rebuked his military comparision and called to question his way of thinking while relating it to real life experience and observation of ICU MD/RN collaboration. Yes I took a few shots at militant stephend but he has been flaming at the mouth for the last few days. The shots were deserved.He is a big boy and im sure can take it.

Why the double standards? if a poster here gets me "riled" up, as happended tonight, believe me you will know it. If it gets them riled up so be it they can go off also. Its typical as soon as someone states an unpopular view here that person is militant and stirring the pot. 1st class private stephend can take all the shots he wants and its gravy. Toughen up Silver. if you want to go to med school please go. You bring good debate to the table but when dealing with those infected with small mans syndrome sometimes you have to give them a taste of their own medicine.

JPP not sure why you are getting riled up. I have not directed one negative comment toward you or your profession. :confused:


This is funny!!

OK, for the record, I'M NOT RILED UP.

I'm only halfway paying attention to the context of these long posts.

If I was getting riled up, believe me, you'd know it.

The only reason I posted was while I half heartedly skimmed BIS's post, I saw something like "get over it, man, ". The FBI profiler came out in me and my crime-fighting mind immediately made the correlation back to the previous assailant's posts....who used to say "whatever man", "get over it, man", etc etc. I therefore opened the realm of possibility that alleged Bis could be Nitecap, or possibly one of nitecap's previous acquaintances...and if the latter, they were probably roommates at one time since they follow what we call in the crime fighting business LASA ....(live alike speak alike)....

stay tuned for more updates from the FBI desk.

ok for the record the above post is made in jest, I'm only half-paying attention to this thread, and have no desire to get into a pi ss ing match . Carry on.
 

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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.

OK, so stephend7799 gets banned for defending his position and nitecap, I mean BIS, continues his constant barrage of anti-physician BS on StudentDOCTOR.net and doesn't get banned?

Hello???? Please tell me what I missing here???? Are the moderators nurses???
 

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SilverStreak said:
To others reading my above post, please excuse my ugly behavior, but I feel it is warranted in the above posters (stephend7799) case. I apologize to anyone I unintentionally offend by reading it. It is not directed at any other physician, and was offered in response to the dimwit idea that nurses don't think for themselves. While I enjoy a thoughtful well argued debate, putting down the jobs of others (housekeeping, nursing, CNAs, scrub techs, anyone) is not necessary, so I reacted in a similar mean spirited way. However, mean or not, I say what I mean and I do stand by my comments to him. Again, sorry to any of you who read my post and get offended.

Problem solved for now. Stephend7799 banned for trolling!
 
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Noyac

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SilverStreak said:
You guys ever gonna let it go? :D He got what he wanted, he's still under everyone's skin on this board. It's only fun to someone like him when he gets you all riled up again and again.


He doesn't bother me in the least. Its the nurses that should be bothered by him. He gives nurses a bad image.
Its people like Stephend7799 that bother me. They give docs a bad image. Therefore, I had him castrated.
 

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Sinnman said:
OK, so stephend7799 gets banned for defending his position and nitecap, I mean BIS, continues his constant barrage of anti-physician BS on StudentDOCTOR.net and doesn't get banned?

Hello???? Please tell me what I missing here???? Are the moderators nurses???


I tried to talk to stephend through a PM politely and he told me to F*ck off. Then he changed his account so as not to receive any PM's at all. So I acted as any of you would have. Stephend has been banned b/4 (remember davvid2700?) as has nitecap/BIS. I know that they are likely the same person but the tone has changed somewhat for BIS. Read my last post, BIS is making nurses look bad and is harming the nursing agenda more than anything here. He gets more and more physicians as well as anyone else that reads this forum to see the type of thinking that goes along with the AANA. If he makes you think about the situation then he has done something that they don't need. He has informed you of their agenda and hopefully started to get you involved in the ASA agenda to protect what you have. If that bothers you then I don't know what to tell you.
 

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BIS said:
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 :laugh: .
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 answer is YES> you have to call me before you give my patient cacl.. Yes you must call the renal doc to make adjustments to the cvvhd machine.
I dont believe in protocols period... every patient is different.. Protocols take the thinking out of medicine... Protocols are for mid level providers.. who cannot think independently.. acls protocols are guidelines... i would not have any problems deviating from them if i felt it necessary Yes you must call for everything.. You must have a physicians order for every single drug to the patient or any adjustment to the medical treatment.. period. If you wanted to be a docor you should have gone to doctor school.. im sorry I didnt invent it.. good luck in court you doctor wanna be.
Why did stephend get banned.. I didnt think he said anything offensive.. Why dont you ban Nitecap,, or bis.. better yet call his program director.. and make a copy of his piosts and send it to them.. Private message me for the address..
 

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Noyac said:
He doesn't bother me in the least. Its the nurses that should be bothered by him. He gives nurses a bad image.
Its people like Stephend7799 that bother me. They give docs a bad image. Therefore, I had him castrated.

You are exactly right.
 

BIS

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Sinnman said:
OK, so stephend7799 gets banned for defending his position and nitecap, I mean BIS, continues his constant barrage of anti-physician BS on StudentDOCTOR.net and doesn't get banned?

Hello???? Please tell me what I missing here???? Are the moderators nurses???


Please go thru any of my old posts and inform me how I am physician bashing. I have never bashed your profession as a whole. Yes I took a few shots at stephend but directed them directly at him. On the other hand I did disagree with views here if that is a sdn crime.
 

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rainking said:
BIS said:
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 :laugh: .
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 answer is YES> you have to call me before you give my patient cacl.. Yes you must call the renal doc to make adjustments to the cvvhd machine.
I dont believe in protocols period... every patient is different.. Protocols take the thinking out of medicine... Protocols are for mid level providers.. who cannot think independently.. acls protocols are guidelines... i would not have any problems deviating from them if i felt it necessary Yes you must call for everything.. You must have a physicians order for every single drug to the patient or any adjustment to the medical treatment.. period. If you wanted to be a docor you should have gone to doctor school.. im sorry I didnt invent it.. good luck in court you doctor wanna be.
Why did stephend get banned.. I didnt think he said anything offensive.. Why dont you ban Nitecap,, or bis.. better yet call his program director.. and make a copy of his piosts and send it to them.. Private message me for the address..


Yeah go ahead and send my posts to nitecaps PD, not gonna effect me much. This is against the rules more than anything. What is a PD gonna get mad at someone for supporting protocols? You guys should drop the whole nitecap thing. You are going in the wrong direction . I will however message nitecap on the allnurses.com forum. If insecure people are threatening to effect his training then he definitley needs to be here.
 

rn29306

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I hope the OP is able to distinguish the AA vs CRNA profession here.
 

droopy1592

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stephend7799 said:
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


Someone has never been in the military. Bad analogy. Let's see that SGT, SSGT, GSGT, MGSGT or FSGT that are under a junior commissioned officer look at that boot LT like he's crazy if he/she gives a senseless order... or one that doesn't stick to "protocol" or SOP . Giving orders!=making decisions. It's a bad analogy because often an officer consults his subordinate snco's.



And for those that think the pred med pre reqs are so much more challenging than pre nursing... they aren't. I've taken both (4.0 GPA in all science/math) complete lists of pre-reqs for both professions. I had too many bouts with indecisiveness. I felt that A&P was a bit more challenging than biology (more memorization), and while I didn't take the same chemistry classes that pre nurse students did, I did tutor them as well as pre med chem students and assist in both labs. They appeared to be every bit as competent as the students in the pre med chem classes, and while the nurse chem class was compressed, they did have a healthy grasp of all of the basics in bio, inorg, and organic chem. There were no pre nursing students in physics class but there were students that were going into engineering and took physics classes but later change their majors to nursing. They had no problems getting As and Bs in physics, both algebra and calculus based.

Many of us fail to see that it's the individual, and not the title that makes someone competent and trustworthy.

Why compare classes when the difficulty of the classes is determined by the professor, not the title of the class... please don't take this out of context, as I know someone will.

There are bad PAs, MDs, and Nurses... the title doesn't make you god or better than anyone else in any profession.

We've all had those professors that we look at and say "how the hell did they make it through grad school?"
 

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rn29306 said:
I hope the OP is able to distinguish the AA vs CRNA profession here.
All was well for the first eight posts or so... ;)
 

sdn1977

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jwk said:
All was well for the first eight posts or so... ;)

Yep...the poor thing was a 22 yo college graduate who was rethinking his/her decision to go to pharmacy school in the fall. Somehow...this got lost in this tired argument. Now...he/she is probably s***less, will go to pharmacy school.....I'll get him/her in an OR rotation in the 4th year & this individual will want to know why this group is so antagonistic (when in real life you're not - I know - I work the OR).

Could you not have kept this within the context of the question????
 
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stephend7799 said:
a year in the icu as a nurse is nothing... if you are not making decisions.. (medical decisions)..


This is were it went south.

Trying to clean this board up. Off to a good start by getting rid of stephend.
 

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Noyac said:
I tried to talk to stephend through a PM politely and he told me to F*ck off. Then he changed his account so as not to receive any PM's at all. So I acted as any of you would have. Stephend has been banned b/4 (remember davvid2700?) as has nitecap/BIS. I know that they are likely the same person but the tone has changed somewhat for BIS. Read my last post, BIS is making nurses look bad and is harming the nursing agenda more than anything here. He gets more and more physicians as well as anyone else that reads this forum to see the type of thinking that goes along with the AANA. If he makes you think about the situation then he has done something that they don't need. He has informed you of their agenda and hopefully started to get you involved in the ASA agenda to protect what you have. If that bothers you then I don't know what to tell you.

Fair enough.

As a former nurse and midlevel wanna-be, this stuff really gets my blood pressure up!!!! If you guys could see the crap that gets pumped into these nurses and especially the NPs and CRNAs you would be shocked!! I can assure you firsthand there really IS an aggressive agenda to change the face healthcare and put doctors "in there place." It sickens me when I read the posts here.

Now that I realize what medical education is really like and how clueless I really was, I have serious concerns for the future of medicine. There is a group (groups, really) of highly organized, politically active people that have no concept of how little they actually know trying, convincingly in many cases, to convince everyone that they can provide equal and even BETTER care than physicians.

If you don't believe this is real, you're in for a big surprise. Anyone who has a stake in healthcare, as a patient or a physician with a quarter mil in debt better wake up and start getting active. I've seen both sides and I'm telling you firsthand, it's gonna get real ugly.
 

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BIS said:
I am not nightcap so get over it. Its impressive that his name lives on like it does. maybe we should chip in a build a memorial. I am far less aurgumentative and have never once had it out with anyone here.

Followed by:

BIS said:
Nothing funny here brown noser, new name = BrownStreak. Now thats funny. I was backing you, you dork and also adding to your aurgument. I addressed stephends inacurrate posts which you called out as well. I rebuked his military comparision and called to question his way of thinking while relating it to real life experience and observation of ICU MD/RN collaboration. Yes I took a few shots at militant stephend but he has been flaming at the mouth for the last few days. The shots were deserved.He is a big boy and im sure can take it.

No implications that the "shots" weren't earned but the post is ironic all the same.

BIS said:
.....You bring good debate to the table but when dealing with those infected with small mans syndrome sometimes you have to give them a taste of their own medicine.

Speaking of "debates" what ever happened to a response to this:
http://forums.studentdoctor.net/showpost.php?p=3762861&postcount=12

I addressed each of your points (rather politely I thought) and what response did I get?
(Sitting at computer listening pensively to the sounds of crickets chirping and the lustful singing of fornicating toads).

You were wondering
BIS said:
Why is it that no one here has the balls to speak their mind and debate the issues?
and where is YOUR reply? The only reply I saw (to another post, now gone) was you addressing one of the Mods in a rather unfriendly way. Surely I didn't win the "debate" with one reply (or DID I?).
 

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Sinnman said:
Fair enough.

As a former nurse and midlevel wanna-be, this stuff really gets my blood pressure up!!!! If you guys could see the crap that gets pumped into these nurses and especially the NPs and CRNAs you would be shocked!! I can assure you firsthand there really IS an aggressive agenda to change the face healthcare and put doctors "in there place." It sickens me when I read the posts here.

Now that I realize what medical education is really like and how clueless I really was, I have serious concerns for the future of medicine. There is a group (groups, really) of highly organized, politically active people that have no concept of how little they actually know trying, convincingly in many cases, to convince everyone that they can provide equal and even BETTER care than physicians.

If you don't believe this is real, you're in for a big surprise. Anyone who has a stake in healthcare, as a patient or a physician with a quarter mil in debt better wake up and start getting active. I've seen both sides and I'm telling you firsthand, it's gonna get real ugly.
Hey Sinnman

It seems that you have had one of those rare opportunities to see 'both sides'. I think a lot of doctors truly believe nurses and midlevels are completely benign and pose no threat whatsoever.

Could you possibly point to some examples of what you have witnessed firsthand? I think with guys/gals like you who have seen both sides, doubters will soon get a wake up call. Why? Well, I'm one of those fellas with nearly a quarter mil in the hole :cool:
 

Tenesma

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silversteak.... okay so your tone has changed from "i make the decisions in the ICU that keep patients alive" to "i have pre-set orders on what I can or can't do" to actually believing that following orders implies that you are assuming the role of decision maker in critical care...

i have no problem w/ experienced nurses following algorithms and protocols - i do have a problem when somebody without any medical training comes on to this board and starts stating that an experienced ICU nurse is the savior...

i quote from Silverstreak: "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. "

I showed this post to my wife (who is an ICU nurse) and she laughed at how delusional you are.... obviously if you are such an astute clinician you can open your own ICU....

when you actually make it through CRNA school you will look back on your postings and understand how ludicrous you sound
 

SilverStreak

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Tenesma said:
silversteak.... okay so your tone has changed from "i make the decisions in the ICU that keep patients alive" to "i have pre-set orders on what I can or can't do" to actually believing that following orders implies that you are assuming the role of decision maker in critical care...

i have no problem w/ experienced nurses following algorithms and protocols - i do have a problem when somebody without any medical training comes on to this board and starts stating that an experienced ICU nurse is the savior...

i quote from Silverstreak: "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. "

Just to clarify, when I say no back up from him, yes we have sepsis standing orders, so he expects that I've got levophed going, I've ordered all the labs, cultured everything, giving fluid boluses, I don't wait on him to do any of this, but with a protocol it was very poorly worded on my part that I don't have any back up at all, it is an easy phrase to misinterpret.

And, when I say we work with what we've got until he gets there, they usually come from the ER with a peripheral on NC looking like crap, so we typically don't have much to work with until the doc gets there, but we do a pretty good job usually with what we do have.

When I say management of the patient is left up to me, I am controling the gtts keeping a pressure, running my blood in, just trying to keep the patient as stable as possible until the surgeon gets there to go back to the OR. It is not a fun place to be for anyone, but the surgeon can't be two places at once, and I can't be at the patient's bedside taking care of what I can if I'm on the phone with him the whole time. We have a system, it may be different from what others use, but it works very well in our units.


I showed this post to my wife (who is an ICU nurse) and she laughed at how delusional you are.... obviously if you are such an astute clinician you can open your own ICU....

when you actually make it through CRNA school you will look back on your postings and understand how ludicrous you sound

Yes I make the decisions in the ICU, based on my protocols. It seems some people here can't distinguish exactly though that we do not just blindly follow whatever we're told to do over the phone or on a piece of paper just because a doctor ordered it. I may sound a little more arrogant in my posts than I am in real life, but if you look at my other posts, I bring a lot of questions here. I realize I don't have all the knowledge you do, nor I am expected to.

But, I can tell you this, when we have a patient going bad, would you want a nurse waiting to check every little thing with you and letting valuable time slip through your fingers, or do you really want me to call you, now i need and h/h, now i need an abg, do you want me to go ahead and order blood? The doctors expect that we know what's going on and anticipate orders in the ICU. I realize what my limits are, I've stated it numerous times in my posts that every nurse should know and not hesitate to call the MD if ever in doubt. All I meant in previous posts was that we have more independence or thinking outside the box even with our protocols than many of you probably realize.

It really doesn't matter what any of you think. You know how the ICUs work, those of you done with your training, and you know there is a fine line between the liberties some ICU nurses take in writing orders.
 

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If I was the pt, I'd hope that the doc gave orders for what he wanted done to me, along with orders for things he wanted done should I take a turn for the worse. I'd also hope that he had enough foresight to write down orders for certain other possible problems (not for me, specifically, but more situational problems), so that when/if they crop up, the nursing staff can start them, then notify my doctor what's going on and what they started to attempt to fix it. Man, it would be really great if there was such a system in place.
 

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psychbender said:
If I was the pt, I'd hope that the doc gave orders for what he wanted done to me, along with orders for things he wanted done should I take a turn for the worse. I'd also hope that he had enough foresight to write down orders for certain other possible problems (not for me, specifically, but more situational problems), so that when/if they crop up, the nursing staff can start them, then notify my doctor what's going on and what they started to attempt to fix it. Man, it would be really great if there was such a system in place.


Its called protocols.
Studies have shown that ICU's with 24 hr physicians and protocols have shorter stays and less M&M.
 

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silverstreak... your delusions persist... lets close this thread it is boring and the OP question has been addressed..
 
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bestiller

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Tenesma said:
silversteak.... okay so your tone has changed from "i make the decisions in the ICU that keep patients alive" to "i have pre-set orders on what I can or can't do" to actually believing that following orders implies that you are assuming the role of decision maker in critical care...

i have no problem w/ experienced nurses following algorithms and protocols - i do have a problem when somebody without any medical training comes on to this board and starts stating that an experienced ICU nurse is the savior...

i quote from Silverstreak: "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. "

I showed this post to my wife (who is an ICU nurse) and she laughed at how delusional you are.... obviously if you are such an astute clinician you can open your own ICU....

when you actually make it through CRNA school you will look back on your postings and understand how ludicrous you sound

I have always found the board to be full of "Rock Star" "Messiah" "Savior" "Been there done that" "veteran" Anesthesiologist. One wonders how such intellectual supernovas, have so much time to post on a lowly student bulletin board, in between performing anesthesia on so many "never done before NJM cases". Especially to bristle at the post of so many lowly "mid-level" providers. I would doubt that many "veteran"neurosurgeons,or CV surgeons troll student bulletin boards. Like the guy you went to high school with that still has his letterman's jacket on 15yrs after he graduated. The again, the aforementioned specialist didn't go into field where a "mid-level" could do their job. :D
 

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bestiller said:
I have always found the board to be full of "Rock Star" "Messiah" "Savior" "Been there done that" "veteran" Anesthesiologist. One wonders how such intellectual supernovas, have so much time to post on a lowly student bulletin board, in between performing anesthesia on so many "never done before NJM cases". Especially to bristle at the post of so many lowly "mid-level" providers. I would doubt that many "veteran"neurosurgeons,or CV surgeons troll student bulletin boards. Like the guy you went to high school with that still has his letterman's jacket on 15yrs after he graduated. The again, the aforementioned specailist didn't go into feild where a "mid-level" could do their job. :D

Anybody ever notice that alotta the trolling ass h o les on this board have ten or less posts?
 

bestiller

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jetproppilot said:
Anybody ever notice that alotta the trolling ass h o les on this board have ten or less posts?
Thanks for making my point JetProPilot! :)
 

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:p
bestiller said:
Thanks for making my point JetProPilot! :)


Let me add to your theory and help you make your point. I am hear b/c I enjoy my job and I like discussing it. You don't see the ones you mentioned b/c they are egotistic (usually) and would not look to others to learn how to be a better physician. They all believe they are the best. I for one have learned a thing or two from this forum and will admit that I am not the best so I am a "STUDENT" of anesthesia. Plus by choosing anesthesia, I have a lot more time on my hands than the two other examples you gave. :p
 

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Its funny how alot of this arguments that are going on boils down to the inability of everyone to look at another's perspective. We feel like MDAs are trying to limit our ability to practice. From this post I see MDAs feel like we are trying to take over medicine. I guess their both valid. At the end of the day, all 3 types of anesthesia providers can provide safe anesthesia and all 3 are needed. Period. No one can argue that point.
Now, of course I gotta defend mine so hear it goes. THIS IS TO CFDAVID (and let me know if these statements are true). Everyone knows what the basic "pre-med reqs" consist of; meaning you can major in ANYTHING as long as you have the pre med reqs. Biochem, Calc based physics, A&P are not requirements for 100% of the medical schools in america (strongly suggested but not required). So technically, you can be a music major and get into medical school or AA school; TECHNICALLY. I like to deal in absolutes. One absolute is a nursing student will take anatomy and physiology, pathophysiology, and pharmacology. I looked at Emory AA website and it wasn't just biology and chemistry majors getting excepted (even though they were the majority). In the last four years they've had Nursing, Psychology, and Education majors get in (which shows that they like people from different backgrounds which is a beautiful thing).
Second point, initially coming out of anesthesia school (and this has been acknowledged by 2 AAs that frequent allnurses) CRNAs for the first year or two do have a little leg up on AAs just because school isn't the first time we've taken care of a patient (in any type of setting except those AAs who were RNs or RTs before). Past that, in an ACT setting, J-dubs right; you wouldn't be able to tell one from the other.
Lastly (and I say this with love), having a military background (GO ARMY.COM), I had the pleasure with working with all types of medical residents ( Walter Reed, Brooke Army) and when they came in as interns - "Shellshocked". By the time they left as an Attending or Chief Resident - "Champions". No MDA on this board can tell me they were GODs gift when they came throught the ICU. That's why its funny to me that you would discount the advice/knowledge of a seasoned well trained ICU nurse when you were so green yourself (as interns or even 2nd years).
A really good nurse can see something is about to go wrong before it actually does. Of course this comes with experience but this is the experience we take with us to the OR. MAN THAT FELT GOOD. Okay, much love, and go MAVS!!
 

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jetproppilot said:
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.

Let's see, I wrote post #3 of this thread way back when, trying to give a factual reply to the pharmacist OP who asked an objective question. As usual the thread has morphed into covering Topic(s) Which Will Not Be Named and has gone on numerous wandering tangents.

And frankly the rewarmed, repeated, and rehashed waste of bandwidth is getting tiring.

JPP, above, succinctly summarized the core truth, and is a simple, liberating, yet monumentally powerful observation . Maybe since JPP and I were in training at the same point in time, and have been away from academia for approximately equal number of years, that to us the mental cost/benefit ratio of arguing how many angels can dance on the head of a pin just isn't worth it.

It's so much more enjoyable and relaxing going into work each day being beyond the need to have my ego stroked, being beyond worrying (or caring) who can piss the furthest, and just concentrating on giving my patient superior care. I learned a long time ago that worrying about trying to be King of the Mountain is a short-lived exercise in futility even if temporarily successful.

No one currently on SDN will be remembered by anyone in 75 years (with the exception of your great-grandchildren), so why get so riled up about stuff? Just go placidly amidst the storm.
 

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psychbender said:
If I was the pt, I'd hope that the doc gave orders for what he wanted done to me, along with orders for things he wanted done should I take a turn for the worse. I'd also hope that he had enough foresight to write down orders for certain other possible problems (not for me, specifically, but more situational problems), so that when/if they crop up, the nursing staff can start them, then notify my doctor what's going on and what they started to attempt to fix it. Man, it would be really great if there was such a system in place.


no i read through your ur sarcasm.. you are probably a disgruntled nurse.. upset about your position.. go to medical school... geez...
 

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I briefly skimmed some of the posts here. Its probably time to let this thread die. There's no point in arguing about who knows what. Also, if you are going into anesthesiology and feel threatened by CRNAs you picked the wrong field. I was an ICU nurse for 6 years before going to medical school. When I was looking into CRNA the CRNAs I talked to told me to go to medical school because they were threatened by the MDs taking all of their jobs one day. This argument has been going on for many years and may be still going on one day when I retire from anesthesiology.

As far as being an ICU nurse, I thought I knew alot when I worked there. After starting medical school I quickly realized that I didn't know jack. Sure I could follow protocals and trouble shoot minor problems but you're pretty much a trained monkey. It's very easy to say someone needs norepi, dopamine, whatever but you don't have an understanding of the physiology on any reasonable level. I know because I was there and I considered myself one of the smart ones. But, I saved alot of interns asses when I was an ICU nurse and I expect alot of the nurses are going to save my ass this year when I begin internship next week. You should learn to work with everyone and respect what they have to say. It will make your life much easier in the long run. Also, as most experienced physicians know, if you piss off the nurses they will make your life hell. The "high and mighty" attitude works great in the movies but isn't really practical in the real world.

Anyway, you guys can keep arguing if you like.
 

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no i read through your ur sarcasm.. you are probably a disgruntled nurse.. upset about your position.. go to medical school... geez...

I am in med school (though, I have never been a nurse). I'm an advocate of the team approach to medicine. Neither doctors nor midlevels can properly (safely) take care of patients without the other. When I become a doc, I don't want the nurses to bother me with every med request (interns are supposed to do that), but expect them to notify me of changes to my patients, and follow the pre-set instructions unless told otherwise. I'm a medic, and used to protocol-driven medicine, and asking for orders, while exhibiting some independant thought.
 

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bestiller said:
I have always found the board to be full of "Rock Star" "Messiah" "Savior"

And yet you still come back.

bestiller said:
I would doubt that many "veteran"neurosurgeons,or CV surgeons troll student bulletin boards. Like the guy you went to high school with that still has his letterman's jacket on 15yrs after he graduated. The again, the aforementioned specialist didn't go into field where a "mid-level" could do their job. :D

The attendings here aren't trolling. This is simply an indication of the overall good-quality-ultra-cool individual that chooses the field of anesthesiology and enjoys their field and enjoys communication with others. I guess you just don't understand.
 

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bestiller said:
I would doubt that many "veteran"neurosurgeons,or CV surgeons troll student bulletin boards. Like the guy you went to high school with that still has his letterman's jacket on 15yrs after he graduated. The again, the aforementioned specialist didn't go into field where a "mid-level" could do their job. :D


actually pretty funnyy..

thats like military md talking about ( when i was a resident.....(insert anything here) ) lol
 

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burntcrispy said:
As far as being an ICU nurse, I thought I knew alot when I worked there. After starting medical school I quickly realized that I didn't know jack. Sure I could follow protocals and trouble shoot minor problems but you're pretty much a trained monkey. It's very easy to say someone needs norepi, dopamine, whatever but you don't have an understanding of the physiology on any reasonable level. I know because I was there and I considered myself one of the smart ones.

Flawed logic. Projecting your experience and knowledge base onto others'. Not gonna argue your central point, because it is self-evident that, by and large, MD's of all disciplines have a deeper and broader knowledge of the why's and how's of medicine than RN's. But the difference in having a "reasonable level" of understanding and not is picking up a physiology textbook, and learning it. Or asking the attending questions until they're walking away, slowly. Or listening closely during rounds. And so on.

I got a BS in biology before getting my BSN. So my science background is deeper than most RN's, I will admit. Or maybe not, since I've forgotten most of it. But working in a busy CTICU (taking orders, following protocols, etc) was an OPPORTUNITY to learn far more about phys, pharm, patho and the like than any classroom. Doesn't mean everyone does, because you still get the same paycheck. But it is still there. My point is that Anesthesiologist Assistants don't get that opportunity, unless they've already worked in a similar clinical environment, but it is not a requisite hoola hoop. Whatever; I'm not anti-AA, I think they've established themselves as competent providers at this point. But I will defend ICU nursing as a very strong -potential- learning environment all day long, even if it is sometimes overstated.

We're all trained monkeys, dude. Admit it.
 

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Cap'nOblivious said:
Flawed logic. Projecting your experience and knowledge base onto others'. Not gonna argue your central point, because it is self-evident that, by and large, MD's of all disciplines have a deeper and broader knowledge of the why's and how's of medicine than RN's. But the difference in having a "reasonable level" of understanding and not is picking up a physiology textbook, and learning it. Or asking the attending questions until they're walking away, slowly. Or listening closely during rounds. And so on.

I got a BS in biology before getting my BSN. So my science background is deeper than most RN's, I will admit. Or maybe not, since I've forgotten most of it. But working in a busy CTICU (taking orders, following protocols, etc) was an OPPORTUNITY to learn far more about phys, pharm, patho and the like than any classroom. Doesn't mean everyone does, because you still get the same paycheck. But it is still there. My point is that Anesthesiologist Assistants don't get that opportunity, unless they've already worked in a similar clinical environment, but it is not a requisite hoola hoop. Whatever; I'm not anti-AA, I think they've established themselves as competent providers at this point. But I will defend ICU nursing as a very strong -potential- learning environment all day long, even if it is sometimes overstated.

We're all trained monkeys, dude. Admit it.

maybe you are a trained monkey but not me... .. .. so if the shoe fits, wear it and go back to the nursing board...
 

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bestiller said:
I have always found the board to be full of "Rock Star" "Messiah" "Savior" "Been there done that" "veteran" Anesthesiologist. One wonders how such intellectual supernovas, have so much time to post on a lowly student bulletin board, in between performing anesthesia on so many "never done before NJM cases". Especially to bristle at the post of so many lowly "mid-level" providers. I would doubt that many "veteran"neurosurgeons,or CV surgeons troll student bulletin boards. Like the guy you went to high school with that still has his letterman's jacket on 15yrs after he graduated. The again, the aforementioned specialist didn't go into field where a "mid-level" could do their job. :D

One day, when I eventually finish all my training, I would love the chance to come to a place like SDN and help out aspiring doctors much as the current crop (jet, mil, UT, and others) have helped us. What is wrong with wanting to help one's future colleagues?
I've noticed that many docs really enjoy teaching and passing on their knowledge to students. I think its great, keep it up all.
 

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VA Hopeful Dr said:
.......
I've noticed that many docs really enjoy teaching and passing on their knowledge to students. I think its great, keep it up all.

I think you would find that in almost any line of work too.

No matter what their calling, some people just want to get through the day, doing what's required of them to earn their paycheck, and go home. To them, teaching is a bother.

Other people derive huge satisfaction as a coach/mentor/teacher. There's something priceless and gratifying about watching a newbie struggle with a concept or psychomotor skill when suddenly the lightbulb switches on and things click into place.
 

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trinityalumnus said:
I think you would find that in almost any line of work too.

No matter what their calling, some people just want to get through the day, doing what's required of them to earn their paycheck, and go home. To them, teaching is a bother.

Other people derive huge satisfaction as a coach/mentor/teacher. There's something priceless and gratifying about watching a newbie struggle with a concept or psychomotor skill when suddenly the lightbulb switches on and things click into place.

Yep! I'd agree.....those of us who like to teach not only like our field of study, we like to share it. Its not for everybody though, but students can tell the ones who love what they do.
 
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