Advice on nursing

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bj

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I have been thinking about going into nursing but every time I mention that I'm interested in this field they ask why. Most people are not encouraging about this field because of the long hours, shift work, esp at nite, the bureaucracy of health care and mostly the crap that you have to put up with from doctors.

Can anyone enlighten me on this subject? So far I've had a very one sided response to this subject and if anyone can give me their two cents, i'd be most appreciative.
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When you speak of "crap", to what specifically, are you referring?
 
By *crap* i refer to some docs who look down on you for being *only* the nurse. Some docs aren't like that but the ones i've run into seem to put down nurses, treating them like servants (for lack of a better word).

I realize the rewards that come with helping your patients, but sometimes docs don't realize what you really are doing for them. What's your view, maybe I'm seeing this through the wrong way?
 
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As a 4th yr med student, I'm certainly no expert on the subject, but it's been my experience that MOST docs treat MOST nurses very well and vice versa. There will always be the occasional arrogant fool who treats EVERYONE poorly, but for the most part, we all get along fine. On the flip side I've met a few nurses along the way who love to torture med students, just KNOW that they are as knowledgable as the docs and in general are very difficult to work with.

But really, medicine is not much different from any other profession. If you're not a team player (doc or nurse) you won't get nearly as much accomplished. Also, since most of us are mature adults, we realize that if we don't get along and respect each other the patients will be the ones that suffer, and NO ONE wants that.

It seems like you've only talked to a few unhappy people. In what capacity have you come into contact with physicians (you state, "the ones I've run into seem to put down nurses")?
 
I am an RN and sure there are some docs who do make you feel like dirt at times (it would happen in any profession). But for the most part, the docs I work w/ value the nurses and respect the job we do. They do listen to our opinions and sometimes even change the pts course of treatment based on what we have to say! It really is all about teamwork...in the medical profession you can't wear your heart on your sleeve!!
 
Think about this, w\o nurses, the hospital would not be able to function for the most part. The medical profession is 100% teamwork. Everyone must work together. Nurses w\doctors and PA's exc. W\O one the hospital would go to the pits.
my .02cents worth
brett
 
I agree with Heart-Nurse's comment....

Besides, it's not only the docs that might look down on nurses.... It can be the other way around.... Some interns or residents get pushed around by "senior" nurses... This may result in breading contempt for that doc to other nurses.

I say, just follow the golden rule "DO unto Others as you want done unto you."
 
Ha! this reminds me of Ben Stiller in "Meet the Parents". :)

Yes working in the Hospital, I have the opportunity to hear many complaints from the nurses. The main one being that the current shortage, doubles the workload..often without compensation. But on the other hand I have seen many nurses blush over the salaries and signing bonuses being thrown at them because of the very same shortage. So I guess it is however you choose to see it.

Also keep in mind, unless you work in the O.R. or maybe the E.R., The doctor is rarely there when you are administering care. I have many college friends who chose nursing. While interning(?) at different hospitals/floors they complained mostly about their co-workers personalties...NOT the doctors. And likewise, they chose a hospital/floor based on their experiences with the personalities they encountered.

The IRONIC thing is most of those nurses who complain the loudest about doctors treating them like nothing turn around and have that same 'malignant' personality with
people who work under them.... I can't count how many times I have been talked to like a little baby.... Hmmmm So maybe what comes around goes around, eh? ;)

Nursing is wonderful! My only gripe against it is that, to me Nurses just 'follow orders'. Even then, if you enjoy making the decisions you can be an NP or a Charge Nurse.
Nursing is wonderful!
 
I work with RN's and RPN's (registered psych nurses) everyday as a psych nursing aid. I too work shifts, and have the long hours. There are times when I would work 3 pm till 7 am the next day and then I'd have to come back for a 3-11 shift. It's tough, but for the most part, it's a very satisfying career. I find, however, that some of the senior nurses tend to have a very arrogant attitude and claim to know more than doctors. In fact, one nurse even claimed that because she has such a general knowledge and that doctors are usually specialized that she knows way more than doctors!
 
bj said:
By *crap* i refer to some docs who look down on you for being *only* the nurse. Some docs aren't like that but the ones i've run into seem to put down nurses, treating them like servants (for lack of a better word).

I realize the rewards that come with helping your patients, but sometimes docs don't realize what you really are doing for them. What's your view, maybe I'm seeing this through the wrong way?
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It's not the doctors who treat nurses like crap, it's the other nurses. Sure, some of the docs will get testy if you call them in the middle of the night, but that is really no big deal. Actually, it can be quite entertaining.
 
I really like nursing and I think in general everything that people have said are true. However, because I work in the ER I have more interaction with doctors and I find that some of the doctors, mainly residents, don't realize how much work the nurses do. SOME (not all by any means) believe that nurses just check vital signs and clean up after patients. That doesn't mean that they look down on nurses however becuase to be honest that's a pretty important part of the job as well. It's just that they don't realize that we do more than just that. All in all though I seem to get a long really well with the doctors and don't get a lot of negative feelings from them.
 
I would say - ignore the negative people and stay focussed on your goal. Some people will never be happy and relish passing on their negative attitudes.

The MD who taught my Anatomy class gave me a good piece of advice and that is to find a niche. Usually people with unique skill sets can write their own ticket, earn autonomy in their professions and usually are somewhat sheltered from the politics at work. I have seen this over and over again in the corporate sector.
 
If you haven't done so, read "Nursing Against the Odds" by Suzanne Gordon. I posted something about this book a while ago (and only Zenman replied).

While many of her conclusions may not apply to the current nursing situation, she does make many valid points.

She talks about physician's treatment of nurses in the past and how things have changed. Nurses need to see and use the power that they have.

I have worked in ER's where we trained 3rd & 4th year med students, and had a residency program as well. I had few problems with the residents and the med students worked very well within the team structure.

Merry Christmas, everyone!
 
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Hamster said:
Nursing is wonderful! My only gripe against it is that, to me Nurses just 'follow orders'. Even then, if you enjoy making the decisions you can be an NP or a Charge Nurse.
Nursing is wonderful!
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Following orders is part of our job description as nurses, I am not disputing that. However, care of the patient is also based on nurses making independant decisions and using your professional judgement to ensure the patient gets the best care. I work in a busy ER, and using my judgement I am the one assigning the acuity of the patient at triage long before the doctor ever sees the patient. By the time the doctor picks up that patient, the labs, x-rays, EKG and minor procedures such as catheters, IV's etc are already done. Of course these are done under protocol, we do not go out of our scope of practice, but we do much more than just follow what the doctor says. I have a patient with chest pain for example, I know what I have to do to start the care of the patient, which labs to order, what needs to be done for this person. I dont sit there and twiddle my thumbs and wait for the resident to pick this patient up in 2 hours and then just go down the list of orders and start doing. A monkey can do that. A good nurse will assess this patient, be able to recognize if this person has the potential to go sour, or who's condition is not stable enough to wait to be seen by the doctor. We must be knowledgable about different diseases and complaints, the treatments for them and the medication among other things. If the doctor orders heparin for a GI bleeder, I am not going to hang that heparin just because "the doctor ordered it". I know that this was probably ordered in error and is inappropriate for this patient. If I just followed what the order said and caused the patient harm, I would be held just as liable as the doctor would for following an order like this. I am not by any means making this response out as Dr's vs. Nurses, I am not that kind of person. I love the doctors I work with (well maybe not a few of them) and they like working with me, we make a good team. They respect my opinions and suggestions on the care of the patient, and when I give them my input even if it is not in agreement with theirs, they always listen and take what I have to say into consideration. We are all human and we all make mistakes. You could easily order medication on the wrong patient (happens commonly with the computer system we use), but because nurses are trained to not just "follow orders", we are smart enough to recognize the mistake and to safeguard the care of the patient. Just remember that we all must work together, and we are both important for the care of the patient. I really respect doctors and all the blood sweat and tears that they put into their careers. Keep up the good work guys and gals!
 
imagin916 said:
Following orders is part of our job description as nurses, I am not disputing that. However, care of the patient is also based on nurses making independant decisions and using your professional judgement to ensure the patient gets the best care. I work in a busy ER, and using my judgement I am the one assigning the acuity of the patient at triage long before the doctor ever sees the patient. By the time the doctor picks up that patient, the labs, x-rays, EKG and minor procedures such as catheters, IV's etc are already done. Of course these are done under protocol, we do not go out of our scope of practice, but we do much more than just follow what the doctor says. I have a patient with chest pain for example, I know what I have to do to start the care of the patient, which labs to order, what needs to be done for this person. I dont sit there and twiddle my thumbs and wait for the resident to pick this patient up in 2 hours and then just go down the list of orders and start doing. A monkey can do that. A good nurse will assess this patient, be able to recognize if this person has the potential to go sour, or who's condition is not stable enough to wait to be seen by the doctor. We must be knowledgable about different diseases and complaints, the treatments for them and the medication among other things. If the doctor orders heparin for a GI bleeder, I am not going to hang that heparin just because "the doctor ordered it". I know that this was probably ordered in error and is inappropriate for this patient. If I just followed what the order said and caused the patient harm, I would be held just as liable as the doctor would for following an order like this. I am not by any means making this response out as Dr's vs. Nurses, I am not that kind of person. I love the doctors I work with (well maybe not a few of them) and they like working with me, we make a good team. They respect my opinions and suggestions on the care of the patient, and when I give them my input even if it is not in agreement with theirs, they always listen and take what I have to say into consideration. We are all human and we all make mistakes. You could easily order medication on the wrong patient (happens commonly with the computer system we use), but because nurses are trained to not just "follow orders", we are smart enough to recognize the mistake and to safeguard the care of the patient. Just remember that we all must work together, and we are both important for the care of the patient. I really respect doctors and all the blood sweat and tears that they put into their careers. Keep up the good work guys and gals!
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I couldn't agree with you more. I work at a busy inner city ER and I have the same experience. The doctors really appreciate a nurse being able to think for themselves. I agree that's it's not a Dr vs. RN thing really I see the two of them working together. Dr.'s don't have time to do all the things nurses do and to be honest RN's don't have the time to do all the things a DR does. So it take a team.
 
I agree for the most part that nurses have more to fear from fellow nurses than from physicians.

I also agree that most docs are appreciative of what we do, even though they might be slightly fuzzy on what it is we do. I'm not sure whose fault that is...is it theirs, because they take us for granted, or is it ours, for not being better advocates for ourselves?

That would be an interesting discussion...what a doc's definition of a good nurse is and what a nurse's definition of a good nurse is. (If it could be a serious discussion, that is, and not degenerate into sophomoric humor/civil war.)

To the OP: you never said why you were thinking of nursing. What do you find about nursing that draws you to the profession?
 
imagin916 said:
Following orders is part of our job description as nurses, I am not disputing that. However, care of the patient is also based on nurses making independant decisions and using your professional judgement to ensure the patient gets the best care. I work in a busy ER, and using my judgement I am the one assigning the acuity of the patient at triage long before the doctor ever sees the patient. By the time the doctor picks up that patient, the labs, x-rays, EKG and minor procedures such as catheters, IV's etc are already done. Of course these are done under protocol, we do not go out of our scope of practice, but we do much more than just follow what the doctor says. I have a patient with chest pain for example, I know what I have to do to start the care of the patient, which labs to order, what needs to be done for this person. I dont sit there and twiddle my thumbs and wait for the resident to pick this patient up in 2 hours and then just go down the list of orders and start doing. A monkey can do that. A good nurse will assess this patient, be able to recognize if this person has the potential to go sour, or who's condition is not stable enough to wait to be seen by the doctor. We must be knowledgable about different diseases and complaints, the treatments for them and the medication among other things. If the doctor orders heparin for a GI bleeder, I am not going to hang that heparin just because "the doctor ordered it". I know that this was probably ordered in error and is inappropriate for this patient. If I just followed what the order said and caused the patient harm, I would be held just as liable as the doctor would for following an order like this. I am not by any means making this response out as Dr's vs. Nurses, I am not that kind of person. I love the doctors I work with (well maybe not a few of them) and they like working with me, we make a good team. They respect my opinions and suggestions on the care of the patient, and when I give them my input even if it is not in agreement with theirs, they always listen and take what I have to say into consideration. We are all human and we all make mistakes. You could easily order medication on the wrong patient (happens commonly with the computer system we use), but because nurses are trained to not just "follow orders", we are smart enough to recognize the mistake and to safeguard the care of the patient. Just remember that we all must work together, and we are both important for the care of the patient. I really respect doctors and all the blood sweat and tears that they put into their careers. Keep up the good work guys and gals!
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"I would be held just as liable as the doctor would for following an order like this"...Since when have you been sued for malpractice? The DOCTOR is held responsible because yes, in fact, you are following his orders, even if they are wrong. The idea of a "team" in healthcare is nonexistent. Yes, it is great that you are able to recognize a mistake and approach the physician about it. I am positive that lives have been saved because of this. However, why does it upset all mid-level healthcare workers that there is a hierarchy in medicine just like there is in any other business? Of course the one with the most knowledge is at the top giving orders because he is the one who is trained in those areas. Does anyone believe that clerical workers are as competent as the CEO of a Fortune 500 company at running a business? No. It's the same concept.
 
megsMS said:
"I would be held just as liable as the doctor would for following an order like this"...Since when have you been sued for malpractice? The DOCTOR is held responsible because yes, in fact, you are following his orders, even if they are wrong. The idea of a "team" in healthcare is nonexistent. Yes, it is great that you are able to recognize a mistake and approach the physician about it. I am positive that lives have been saved because of this. However, why does it upset all mid-level healthcare workers that there is a hierarchy in medicine just like there is in any other business? Of course the one with the most knowledge is at the top giving orders because he is the one who is trained in those areas. Does anyone believe that clerical workers are as competent as the CEO of a Fortune 500 company at running a business? No. It's the same concept.
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In your instance the nurse and MD would be sued. Yes, the MD is the top of the medical heirarchy but nurses are named in lawsuits for following orders that are incorrect or inappropriate. Actually, in a pharmaceutical error, the MD, pharmacist, and RN are named. Like it or not, the RN is the last line of error catching before it reaches a patient and following an inappropriate order without question will result in the RN directly being named in the lawsuit. I do realize that the net is cast far and wide in lawsuits, but the chain of events goes directly through the RN, and thus, the nurse is directly named. Medicine and nursing are judged by their own respective boards. The Nurse Practice Act, Standards of Care, and Scope of Practice all fall into play here for RNs. Don't believe it, then you haven't been in medicine very long MS.
Actually, I have to go and give a deposition for a patient dying of a decub ulcer after emergent AAA surgery 3 years ago. Who are the two members directly named you ask? The MD and a wound care RN.

Next time you spout off about "midlevels", please understand that staff RNs are not considered midlevels. A midlevel is a provider or physician extender and that person would be designated a NP, PA, CRNA, AA, or midwife. The circumstance described talks about a staff RN following an MD order. Just for future reference.

And I believe we can do without the 'doctor' in capital letters.

Your imagined CEO and clerk story doesn't exactly fly in this circumstance.
 
Just to follow up. In situations of a medical error typically the person that is being sued is the one with 'deep pockets'. In other words who they can get the most money out of. Typically that means the hospital even before the doctor.

If you need another example of how everyone can be blamed for an error look what happened when the wrong blood was given to a patient at Duke a few years back. Everyone was in trouble not just the doctor.
 
megsMS said:
"I would be held just as liable as the doctor would for following an order like this"...Since when have you been sued for malpractice? The DOCTOR is held responsible because yes, in fact, you are following his orders, even if they are wrong. The idea of a "team" in healthcare is nonexistent. Yes, it is great that you are able to recognize a mistake and approach the physician about it. I am positive that lives have been saved because of this. However, why does it upset all mid-level healthcare workers that there is a hierarchy in medicine just like there is in any other business? Of course the one with the most knowledge is at the top giving orders because he is the one who is trained in those areas. Does anyone believe that clerical workers are as competent as the CEO of a Fortune 500 company at running a business? No. It's the same concept.
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THIS! This is the "crap" nurses refer to when dealing with MD's. This post is so ridiculous that it's most likely flamebait, but more than a few physicians do have this attitude, so it's worth addressing.

Medication: The nurse, being someone who had to study pharmacology in school and who had to pass the NCLEX, is someone who is educated and therefore responsible for any medication administered. He not only gives the medication, he assesses the patient before and after, ensuring that the drug is helping the patient and not making things worse. He needs to know what drugs can counteract the effects of a drug and have them ready (eg mucomyst for acetominophen) in case the patient goes bad. That's all before the MD is called. Nurses ARE held liable for meds they pass.

Instead of spouting off about things you have no knowledge of, why not use your superior intellect to look up the guidelines set by your state board of nursing, and by your hospital's department of nursing to learn exactly what nurses are and are not responsible for knowing and doing.

Clerical workers, while an essential member of a Fortune 500 company, are hardly analagous to members of a profession in which they are required to have at least 2 years of college-level education and are required to pass national board exams to be allowed to practice. 2 years being the minimum, most hospitals are moving to hire mostly RN's with a Bachelor of Science in Nursing because studies show over and over that nursing care by BSN's result in lower patient mortality.

If you really want to know about the 'crap' that nurses deal with on a regular basis, you should lurk on allnurses.com or gooogle 'nurse abuse physican' or 'physican disruptive behavior'. I'm a nursing student (2nd degree), with no power and no 'toxic attitude'. I've encountered both physicians who seem genuinely interested in educating students, even nursing students they briefly encounter, and others (mostly residents) with big ol God-complexes about being a physican. And I've encountered "we eat our young" nurses as well as good ones. However, physican abuse drives nurses out of the profession.
 
http://www.findarticles.com/p/articles/mi_m0FSL/is_3_74/ai_80159514/pg_3 in 2001

AORN Journal, Sept, 2001 by Janice K. Cook, Meredith Green, Robert V. Topp

"Seventy-one nurses (91%) reported experiencing at least one episode of physician verbal abuse during the past year. Of these, 32 (45%) reported experiencing verbal abuse several times per year; 16 (22.5%) reported experiencing verbal abuse once per month or less; four (5.6%) reported experiencing verbal abuse once per week; 16 (22.5%) reported experiencing verbal abuse several times per week; and three (4.2%) reported experiencing verbal abuse every day. Seven nurses (9%) reported they never had experienced verbal abuse. The five types of verbal abuse that occurred most frequently were abusive anger; condescension; abuse disguised as jokes; ignoring; and blocking and diverting (Table 3). The five types of verbal abuse that caused the most stress included abusive anger; condescension; accusing and blaming; judging and criticizing; and blocking and diverting."
 
I agree with cooperative team work model for achieving that safest most effective care of patients.

However, as someone who works under nursing staff, by comparison, the physicians i've worked with have been courteous if somewhat aloof, while all the abuse I've recieved has come directly from nurses. As most of my co-workers would agree, my response to the above post is that despite the efficacy of team work in patient care the hierarchy of abuse and more impotantly who's dishing it and who's taking it, more resembles the actual practice of healthcare in my experience. So as the old saying goes...**** rolls down hill.
I don't forsee any change in this structure except that which must be mitigated by the increasing power of nursing organizations in the healthcare market due to the strivings of nurses over the past few decades. Nurses will continue to make gains in their ability to determine their own agenda both at the expense of physician hubris and at the rights of those who get trampled by their numbers and political power. I liken it to the emergence of a middle class in the adolesence of an industrial economy.--Ben.
 
Merovingienne: As a seasoned nurse, let me give you a piece of advice. If you have a doc who is being verbally abusive, give him or her "fair warning" that you won't tolerate being spoken to that way. Give him/her the opportunity to straighten up and act like a professional. If the abusive behavior continues, WALK AWAY. If it's a phone call, say, "I'm going to hang up now. You may call back when you can discuss this calmly." Then hang up.

Write it up as an incident report, notify the supervisor. Do not tolerate this behavior. It is unacceptable, no matter the circumstances.

I've rarely had to do this, but every now and then I come across someone who mistakes me for his/her personal punching bag. Wrong, wrong, wrong.

I can overlook someone having a rotten day, but someone who is consistently a bad actor...sorry. Not in my job description to put up with that.
 
Here is a good example for you about how the crap rolls downhill. A few years ago my hospital picked up a product to desolve clogs in feeding tubes. The physician ordered it IV and the nurse thought something was a little fishy so he (I think it was a he) clarified it with the physician that it was in fact IV and was told to give it that route. The pharmacist dispensed the medication and when the nurse looked at it questioned their charge nurse and was told to give it how the doctor ordered. So then they called the pharmacist again and were assured that it was to be given IV. After giving it, the patient died. So who was fired, the nurse that gave the medication. The pharmacist later quit but the doctor continued on like nothing happened. I don't know if a law suit was ever filed or not but the hospital definitely sided with the physician.
 
If it doesn't sound right, don't do it. But you're right, TusconDDS, everyone involved should have been disciplined, not just the nurse. But that's how it goes. It's no news to nurses; we see it all the time.
 
megsMS said:
"I would be held just as liable as the doctor would for following an order like this"...Since when have you been sued for malpractice? The DOCTOR is held responsible because yes, in fact, you are following his orders, even if they are wrong. The idea of a "team" in healthcare is nonexistent. Yes, it is great that you are able to recognize a mistake and approach the physician about it. I am positive that lives have been saved because of this. However, why does it upset all mid-level healthcare workers that there is a hierarchy in medicine just like there is in any other business? Of course the one with the most knowledge is at the top giving orders because he is the one who is trained in those areas. Does anyone believe that clerical workers are as competent as the CEO of a Fortune 500 company at running a business? No. It's the same concept.
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I don't know if you are a pre-med or an intern or whatever, but obviously you are not familiar with how lawsuits unfold. You think that I wouldn't be sued if I followed an inappropriate order? You bet your ass I would! Nurses are often named in lawsuits with MD's, and if you don't know that by now you better learn, just as you better learn that working as a team is not "non-existant". You need to work with your nurses, techs, midlevels and whatever, or you will NOT be able to do your job. I dare you to tell your medical director that you don't see yourself working as a team with the nurses, your butt will be out of there faster than you can say "nurse". Don't compare nurses to clerical staff, we are educated professionals, your analogy is not even close. Go ahead, keep that attitude when you go into the working world. You will wonder why noone will help you or back you up. Because you are so superior and can do everything yourself, you dont need your "team".
 
I don't think any member should be disregarded, imagin916. Those unit secretaries may not have gone to school as long as other healthcare providers, but just try getting your job done if the unit secretary doesn't like you. They an make or break a hectic shift.

And I've personally witnessed unit secretaries who've caught med errors before the nurse had a chance to get his/her hands on the chart. They're essential to pt. care.

MegMS just sounds like a very young student who hasn't had much experience in the real world of patient care. Give her a couple of years. If she's like that when she's an intern, she'll be in for a looooooong year (and little sleep when on-call).
 
As a matter of fact...

As a nurse... I have had to call a few MDs and say... are you Sure you want to do this...??? Usually they say "thank you for catching that"! I as a nurse have also on a few occasions had to out right refuse to carry out orders that were inappropriate!

I have had to personally stand in a MDs face... up close and personal and demand that they tone down the disrespect they were directing to fellow nurses, quit shouting, cursing, and throwing things! (I'm usually the only guy around!)

As a nurse I have seen the contempt a few MDs have had for some nurses... sometimes warranted... most times not! As a nurse... I have seen the comtempt that lots of nurses have for other nurses (I'm a BSN... you are a ADN...so what we are doing the same job for the same pay... with the same outcomes... I'm better than you because you are "Beneath" me... but these same nurses working in the same setting along side of MSNs feel that they are equal... :confused: ) and ANYBODY on the healthcare team that was not a nurse (EMTs, RTs, PAs, AAs, Clerks, Phlebo, Lab, etc).

Still today...
As a FNP & PA-C... I see the same BS!

It is mainly all about Egos... and is not about a patient centric healthcare team... :(

DocNusum, FNP, PA-C
 
Oh God, the old "ADN/BSN/Diploma" debate. :rolleyes:

You're right, DocNusum, nurses do catch med errors, inconceivable as it may seem to some here. I've also dug my heels in and said, "I'm sorry, but I will not give that med/take off that order."

Interesting that you're both a nurse practitioner and physician's assistant. Whose regulations do you have to follow when it comes to prescribing? :confused:

Seems confusing, but I'm sure there's a really good reason for going that route.
 
fab4fan said:
Seems confusing, but I'm sure there's a really good reason for going that route.
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I'm with fab4fan. There is a story here folks. Just wondering if you'd like to share it with us sometime.
 
IMO..one of the absolute worst jobs is unit clerkship.
Unit secretary= babysitter, chart finder, mediator/referee, telemetry watcher, punching bag (fill in the anything you wish here) You are given new things to learn on a daily basis, they'll change your computer system after you've spent months training others how to use it, and when something isn't done correctly one of the first phrases you may here is "the order wasn't transcribed right". Piss off a unit clerk and as an ICU nurse you may find in one shift you've traveled with your ventilated, alined, swanned patient to ultrasound, cat scan, and then once you've have the patient settled need to go for a spin to VQ. It is a tough tough job and everyone should just spend half a day at the desk covering the US.

Regarding lawsuits, I just finished a 5 year process of supenoa and deposition for a wound/decub issue. I was actually a manager at the time of the occurrence and covered the patient for 1 hour when the original nurse was off the unit. Deep pockets is right...the whole damn place was being sued.

And last...everyone who has the authority to write an order has been called at least once by a nurse (pharmacist, secretary...)who picked up on something that could have proved disasterous. If you say your above error because you are the DOCTOR or NP or PA...you're crazy.

Unfortunatley nursing is still a 'service' industry and the praise and acknowlegement isn't also in abundance. The public needs to really embrace nursing everyday...not just the first week of May.
 
DocNusum said:
As a FNP & PA-C
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Off topic, but as an NP and PA, have you been on the thread about differences between NPs and PA?
 
Nope...!

I bit my tongue... and stayed out of that one... :idea:

First off... When the concept of the "mid-level" practitioner (not CNM or CRNA) was dreamed up at Duke University... the first and obvious choice was nurses. The nurses turned down the new role because of politics. My NP/PA program director was one of the original nurses that turned down the role. She said that the nurses didn't want "another" sub-servient role to MDs! So they decided to train and use ex military medics. Shortly after... The nurses came up with NPs.

There are 2 or 3 Duel NP/PA programs in the nation... There used to be 4.
In these programs... If you entered as a RN... you graduated with both FNP AND PA designations... you could sit for both national exams. I attended one of these programs and UNLIKE MOST NP PROGRAMS... ALL students in the program attended ALL of the same classes and ALL were required to clock ~2500 clinical hours in IM, Surg, OB-GYN, Peds, EM, HIV, and Inpatient Medicine on a hospitalist team and elective rotations. The program's philosophy was:

... offers students a curriculum that combines the traditional concepts of both physician assistant and nurse practitioner training. This reflects the program philosophy that no functional distinction in practice exists between these two types of primary health care professionals.
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I decided that it would be best for professional latitude. So I moved my family (Wife and 3 kids) across the country to attend! I work as either a PA or a FNP... but not both in the same setting. The duel designations just give me more options. It's not like I do anything different while taking care of patients in daily practice.

I'm one of the FNP/PA-Cs that happens to speak it as I see it based upon 19 years in healthcare...
So for the "record"...
Average PA Clinical Hours are ~2200 give or take 100hrs
Average NP Clinical Hours are ~650 give or take 100hrs
ALL NPs DO NOT Have Masters degrees... that requirement is ~ 5 years old... And NPs have been practicing since the 60s!
Up until then (2000)... there was a mix of certificate, associate, and bachelors NP programs. Just like the PA programs today.
Still today... You can get a NP ONLINE if you can set up 500 hours of shadowing with a NP or MD... you just need a MSN to sit for the national test! Not to enter the program and graduate!
There are now PA programs that take students without any healthcare experience... this is reletively new (~5 years). The requirement used to be > 2000hrs of documented, paid, verifiable previous healthcare experience in a direct patient care role... not so at many programs anymore.

I believe that BOTH NPs and PAs do a great job at extending healthcare.
I believe that PAs recieve better clinical training for the job both professions are tasked with.
I believe that NPs and PAs become ~ equally able practitioners after the NP gets a few years of actual practice under their belt due to low clinical hours.
Working as a Nurse and then a NP are two completely different roles... So the low clinical hours aren't enough!
I believe that ALL NPs should be FNPs... and then specialize at will.
I believe that a new grad PA will run circles around a new grad NP if the PA went to PA school as a Nurse, EMT, RT.... due to the intensity of clinical hrs required in the PA program.
I believe that the nurses were smart when they chose to decline ANOTHER "subservient" role to MDs/Medicine, but use "semantics" to practice medicine daily by calling it "Advanced Nursing".
I believe that PA and NP training per se... is NOT Masters degree work... although one is issued from most... NOT ALL Programs (the Masters for NPs requirement only went into effect in 1 Jan 2000) and changing the title on the sheepskin means nothing!

I believe that the "We are better than them...from both sides is counter-productive... childish, silly, and Bull-S4it.
I believe that ALL "Mid-Level" providers should cut the nonsense, unite... and challenge the MDs notion that they should be the end all to patient care.

Years of personal experience has demonstrated that both NPs and PAs can do a great job extending healthcare.

I'm just sick and tired of being sick and tired of NPs bashing the PA profession.

PAs generally don't parrot misinformation about NPs in daily practice, but as a nurse... I hear/heard it regularly from nurses/NPs.

PAs haven't opposed and obstructed NP practice goals at state and national levels... Nurses/NPs do this regularly... (Mississippi, Ohio and several other states come to mind).


I've had nurses challenge me as a PA... but never as a NP... :confused:
I've also been around nurses as a NP and listened to how they truely felt about PAs.

Cyndee said it like this:
Just remember, there are a lot more of us coming out of school than you guys. We are aggressive and we're getting things done in the legislature. We're also no longer sitting back and putting up with the way PA's are constantly trying to drag us down. It's all sour grapes, and we thrive on it!
Click to expand...


Some people Just don't play well with others!

My $0.2

DocNusum, FNP, PA-C
 
DocNusum said:
My $0.2

DocNusum, FNP, PA-C
Click to expand...

Great, thanks. That was worth more than $0.2, LOL!
 
Man that was a cool post from someone who has been there and done that on BOTH sides of the fence. Not too many people can argue with you about the roles.

Thanks for the post.
 
DocNusum, that was really interesting. I've been an OR nurse for 6 years, am wanting to become a mid-level, and am looking for answers related to which route I'd be better off choosing (PA vs. NP) to work with a group of Orthopedic surgeons in the end.

I've valued my time as a nurse, but would like to get out of nursing. And I'd like to take a moment and go back to the "crap" that was mentioned in the original post of this thread. (My 2 cents, anyway.)

1. Physician-nurse attitudes. Often, all nurses get lumped into the same category by docs. If one screws something up, the doc looks at the rest more skeptically. (I saw this more when working on the floor.) I came to surgery, and found the working-closely-with-doctors and having them know my name/abilities a breath of fresh air. They know what I know. They know that I'm incredibly Type-A. They know they can trust me. That said, their interests are supreme. That's the way it goes. So, as long as you're willing to move fast and work like a skilled, intelligent drone, they love you.

2. Nurse-nurse attitudes. Nurses are harder on nurses than docs are. In the OR this rings especially true. And, I hate to say it girls, but the guys aren't nearly as mean to us/each other as we are to each other. The catty, critical stuff is pretty bad (in the OR anyway). Too fast, not fast enough, too thorough, not thorough enough, rude, too sweet...

3. Administrator-nurse dynamics. I've known of a handful of nursing administrators who had nursing experience and remembered that providing skillful, compassionate patient care isn't easy. (They usually fight for our interests, and get fired for it.) By far, though, most administrators either don't have much actual patient care experience, forget the trials of "being in the trenches", get comfy in their desk jobs, or are just completely out-for-themselves. Decisions that negatively impact our ability to do our jobs and do them well are being made all the time.

4. Patients' family-nurse dynamics. As society continues to be consumer-driven and lay people learn more and more, patients and family members get bolder and bolder in "protecting" themselves and their loved ones while in the hospital. As well-intentioned and justifiable as this is, it sometimes makes it really hard to do your job. They often don't realize the priorities that nurses are faced with. I once had the wife of the least-sick of my 5 patients dragging me back to their room my entire 10-hr shift. One of my other patients was crumping hemodynamically, one of my patients required a lot of time-consuming post-op nursing care, one was in need of really active pain management...

5. Budget issues. Short-staffing among nurses. Not being able to get needed supplies (This is my current nightmare in surgery; I'm the specialty coordinator for a blossoming orthopedic service; Frustration for me and leads to a lot of pissing and moaning from the surgeons). Having your nursing staff replaced by cheaper unlicensed people who, try as they may, are not even close to providing the same level of skill/assistance.

6. Pay. I'm lucky enough, right now, to be in a region that pays nurses fairly well for what we do. Having worked in Iowa a few years ago, I can attest to the fact that getting a job at the mall would've often paid more than nursing wages.

7. Liability. Although there are certainly ways that nurses can protect themselves, their patients, and physicians from mistakes occurring AND doctors/LIPs are regarded in applicable situations as being the ultimately-responsible party for orders, diagnoses, etc., nurses will always have the risk of being sued. Lizzied, the "deep pockets" thing is right. The problem for nurses is that, even though you aren't really the one with deep pockets, if the hospital is the one being sued, and selling you out is in their best interest, good luck.

Add to all of these things the fact that getting puked/pooped on is usually regarded as an unpleasant thing, the fact that you're working in hazardous conditions (blood & body fluids, radiation, chemicals, etc.), and any other "crap" that I've neglected to mention, I'd think long and hard about nursing and make sure that whatever career you choose involves characteristics that you really enjoy.
 
I just came across this thread and found it interesting, so I thought I would insert my $.02.

I have worked as an ER RN for about 2 years now. I am a BSN and CEN, both of which my hospital feels the need to display on my name badge (I think they just like to brag about certifications). I don't know if the "display" of my "credentials" has anything to do with it or not, but I haven't had too many altercations with docs. Only a couple of times have docs tried raising their voices at me in a non-emergent situation, where they were trying to lay down some law they thought I should follow...all it takes is an assertive nurse to say, "Talk to me when you drop the attitude" and attitudes change. I've noticed, however, that sometimes the nurses who are ADNs and don't have their "credentials" listed on their name badges get treated poorly by docs...usually the same docs that are rather pleasant to us with all of the initials after our name. I have actually had a few docs come to me and ask me to implement an order,assess a patient, or perform a procedure on patients that were not my own just because they felt more comfortable with someone with BSN after their name performing said task. I don't know if that is just the politics of the hospital I'm at, but that just seems to be my observation. In my observation, there are PLENTY of ADNs out there who are EXCELLENT nurses and who can critically think through just about any situation. They can act quickly, think on their feet, and get the job done just as well as someone with a BSN. It's all about the mindset - someone who truly loves nursing will be good at it, no matter what their level of degree, simply because they put the time in to learn and put the time in to understand things and seek new opportunities.

There are one or two docs that (thankfully) don't come around my ER often, and they are just cranky in general to everyone and treat the nurses like dirt. I think in ANY environment someone or some group of people is bound to get trashed...that is just the nature of putting a group of diverse people with diverse attitudes and personalities together and expecting them to work functionally and efficiently as a team. In my experience, its the NURSES that as we were told in school "eat their young." As a newbie nurse, I was treated extremely shabbily by just about every nurse in the ER. Regardless of what degree I had, which school I went to, what my background was (I had already had 2 years of LPN experience on a med/onc unit before graduating), the nurses didn't care - they still treated me like a scrub and took every opportunity to make my life miserable. I had to earn my stripes. And I STILL don't get treated that well by nurses who have been nursing for 15...20...25 years. I actually get treated better by the DOCS than I do some nurses. I think that's just the way it is, unfortunately.
 
bj said:
By *crap* i refer to some docs who look down on you for being *only* the nurse. Some docs aren't like that but the ones i've run into seem to put down nurses, treating them like servants (for lack of a better word).

I realize the rewards that come with helping your patients, but sometimes docs don't realize what you really are doing for them. What's your view, maybe I'm seeing this through the wrong way?
Click to expand...

that's true based on experience of many nurses especially here in the philippines. I am a nurse also. But I promised to myself that I will be a doctor too...

I have experienced being a nurse and i think that it wouldn't be a prob to me when that time comes..:)

godbless
 
Very few doctors (or midlevel providers, or other nurses) will treat you badly if you do your best for the patient, and provide competent care. Know your stuff and if someone wants to be in a pissy mood, it's rare, but that's their problem.

After my first year or so of nursing, I found that I was treated very well by members of the health care team. Just do your best to know your job (and the patient) very well. Be assertive and direct, don't stab people in the back, and become proficient at gently confronting people that are destructive to others.

Good luck! I think nursing is the best job in the world.
 
DocNusum said:
Nope...!

I'm just sick and tired of being sick and tired of NPs bashing the PA profession.

PAs generally don't parrot misinformation about NPs in daily practice, but as a nurse... I hear/heard it regularly from nurses/NPs.

PAs haven't opposed and obstructed NP practice goals at state and national levels... Nurses/NPs do this regularly... (Mississippi, Ohio and several other states come to mind).


I've had nurses challenge me as a PA... but never as a NP... :confused:
I've also been around nurses as a NP and listened to how they truely felt about PAs.

Cyndee said it like this:
[/b]

Some people Just don't play well with others!

My $0.2

DocNusum, FNP, PA-C
Click to expand...

This, unfortunately, is true. Although I've had a few PAs initially get pissy with me simply because I'm an NP, once I told them that I felt that we all have our strong points and not strong points and I'm here to work together and not against them, they quickly quit. But I keep hearing people say, "An NP is above a PA, right?" I have no clue where they get that from, but it makes me embarrassed to be an NP sometimes.

I've also had nurses confront me when I worked in the ER, thinking I was a resident or a PA, who proceeded to rip my head off for some minor or perceived infraction of the rules. When I got very... umm.... "assertive" in my response and/or they found out I was a nurse, they got off my case immediately.

I do my best to promote harmony whenever I can. I hate mid-level providers (or any provider, for that matter) that promote their inherent superiority over all other members of the team, and sadly, more of those types tend to be NPs. I'm here to tell you though, that thankfully, we're not all like that. :)

Kim, CRNP
 
fab4fan said:
I don't think any member should be disregarded, imagin916. Those unit secretaries may not have gone to school as long as other healthcare providers, but just try getting your job done if the unit secretary doesn't like you. They an make or break a hectic shift.

And I've personally witnessed unit secretaries who've caught med errors before the nurse had a chance to get his/her hands on the chart. They're essential to pt. care.

MegMS just sounds like a very young student who hasn't had much experience in the real world of patient care. Give her a couple of years. If she's like that when she's an intern, she'll be in for a looooooong year (and little sleep when on-call).
Click to expand...

As a current unit secretary, thank you!
 
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