Doctor shortage: A nurse may soon be your doctor

[deleted307836]

I really asked because I wanted to know. No insult, no reason for doing so.

...the heck are you doing on the "All Nurses" forum? Don't you have anything better to do? Honestly, I want to know.

Honestly, that is an insulting way to ask why he was there.

Mooshika, why did you become a nurse?

Sorry if you answered that before, I haven't been following this thread from start to finish.

---

Members don't see this ad.

 

[mooshika]

Ha Ha Ha Ha very good. I simply can't get the hang of nursing diagnosis - I am just so bad at it, I never understood it, and it seemed like kind of a load of cr*p, but that was my defense because basically I was terrible at it and have no instinct for it at all. It doesn't make any sense to me, and that is not to say it does not make perfect sense to others - not me. I kept getting my care plans handed back to me to "fix." Don't ask me about care plans either. How much can you go on about skin breakdown?

Can't do it. Came up with something but I needed "extra help."

is that a nursing diagnosis?

 

[RogueUnicorn]

Ha Ha Ha Ha very good. I simply can't get the hang of nursing diagnosis - I am just so bad at it, I never understood it, and it seemed like kind of a load of cr*p, but that was my defense because basically I was terrible at it and have no instinct for it at all. It doesn't make any sense to me, and that is not to say it does not make perfect sense to others - not me. I kept getting my care plans handed back to me to "fix." Don't ask me about care plans either. How much can you go on about skin breakdown?

Can't do it. Came up with something but I needed "extra help."

finally, we agree on something.

 

[mooshika]

Oh for goodness sakes, get a hold on yourself man! I am not insulting anyone! If you insist that I am writing insults out my fingers, I suppose I can't argue with a crowd.

That's a personal question. You will have to PM me.

Honestly, that is an insulting way to ask why he was there.

Mooshika, why did you become a nurse?

Sorry if you answered that before, I haven't been following this thread from start to finish.

 

[Concubine]

I'll save you all the conversation and tell you why this is happening.

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

Obviously from the numbers a lot of med students only care about enriching themselves. If med students truly cared about helping people they would fill ALL primary care residencies because this is essentially one of the main the "frontlines" of health care. THIS IS NOT THE CASE. Most of that junk pre-meds say on their PS is bogus anyway, just to get in. At my university I've worked under several professors who teach in med school pre-rec's and they all have said the same thing to me. It's just recycled junk that adcoms hear every year. If any were smart they would present themselves in a different and unique manner. We live in a world of greed. I commend both Nurses and EMT's for doing the dirty work ( literally) for much lesser pay. These are the individuals who TRULY CARE and they should not be disrespected.

Your assumption is that EMTs & Nurses do the dirty work for lesser pay because they truly care, & most doctors do what they do because they don't. Care to back up your assumptions? I can think of more than a few flaws with your thinking.

You will realize real quick once you enter med school & get your first interest statement, that becoming a physician is a very inefficient way to make good money, especially in these uncertain times.

 

[mooshika]

I am not in love with the job.

But... I LOVE great nurses. I am simply not nearly awesome or remarkable enough to be a good nurse. Maybe I am just not that compassionate, or maybe Im not such a great person.

finally, we agree on something.

 

[RogueUnicorn]

For me, I hate nursing and the whole approach. I am the wrong personality. It was almost insulting, some of the stuff they "taught" us. I hated nursing school, I was always in trouble, and a good 70% of it was a waste of my time. I would not normally say this on this forum because I think it is worse to disparage another's profession, especially nursing, because it is easy to come off, especially if you are medically-oriented, as arrogant and mean. It does not go over well in interviews. It is just for ME that I hate nursing. I really tried my girl-scout best, but I was miserable. What is far WORSE to me, is Nursing theory. I would rather chew my leg off. What BS. I used to tell my mom (RN of 60+ years who felt the same way about my curriculum as I did, it was the "BS" part of the BSN.)

But... I LOVE great nurses. I am simply not nearly awesome or remarkable enough to be a good nurse. Maybe I am just not that compassionate, or maybe Im not such a great person. But I found a lot of what they were teaching in nursing school to be ridiculous. However, I loved the advance practice, NP courses, advanced patho, pharm, physical assessment and diagnostic reasoning, and I really liked psych. And I really like the ED, and where I work now - I don't really do "nursing" it is different. I love doing assessments and write ups, and working with patients, and I am a mad patient advocate - don't mess with my patient... access to health care, all that. community based health programs, prevention - all interests of mine that align with nursing, but can't own it as my profession.

But bedside nursing? No way. Care plans? WTF?

amen.

 

[The right Path]

I strongly disagree that it's much of an exception.

I'm still waiting to hear examples. Do I need to invite you over for dinner? I'm making chicken breasts with raw puttanesca sauce with roasted capers, green salad, and grilled ciabatta. Bring Pinot Grigio and you're in.

 

[sideways]

I'm still waiting to hear examples. Do I need to invite you over for dinner? I'm making chicken breasts with raw puttanesca sauce with roasted capers, green salad, and grilled ciabatta. Bring Pinot Grigio and you're in.

I love how everyone online pretends they eat like ****ing Emeril Legasse every night. Dude's eating a Stouffer's Salisbury Steak and a sleeve of frosted donuts and washing it down with a Gatorade Ice.

 

[The right Path]

you all know what the biggest waste of hospital resources are right? social workers... priceless. Flame on!

I'll disagree with you on that one. They are great for dealing with a lot of the psychsocial issues that I truly have very little time for. Physicians don't have time to sort out who is going to be allowed to visit, who the real DPOA is, etc, etc, either. They help patients with disability forms, medicare/medical forms which is great because then the hospital gets paid. They help ensure that discharged patients and families get connected with the resources they need to fly on their own.

 

[RogueUnicorn]

I love how everyone online pretends they eat like ****ing Emeril Legasse every night. Dude's eating a Stouffer's Salisbury Steak and a sleeve of frosted donuts and washing it down with a Gatorade Ice.

none of that sounds particularly daunting to make, but ohhhh kaaayyy man

 

[sideways]

none of that sounds particularly daunting to make, but ohhhh kaaayyy man

Oh is daunting what I was getting at?

 

[The right Path]

I love how everyone online pretends they eat like ****ing Emeril Legasse every night. Dude's eating a Stouffer's Salisbury Steak and a sleeve of frosted donuts and washing it down with a Gatorade Ice.

It's from Rachel Ray's: 365 No Repeats cookbook. I use it a lot.

I do have a kiddie Emeril cook book- There's a Chef in my Family.

I use that a lot, too.

Last night my hubby grilled pork tenderloin and I made some pesto sauce for farro. And Giada's berry strata for dessert.

I'm not in college anymore, Dude.

 

[The right Path]

none of that sounds particularly daunting to make, but ohhhh kaaayyy man

Exactly. It is quick, easy, healthy, and tasty.

 

[sideways]

It's from Rachel Ray's: 365 No Repeats cookbook. I use it a lot.

I do have a kiddie Emeril cook book- There's a Chef in my Family.

I use that a lot, too.

Last night my hubby grilled pork tenderloin and I made some pesto sauce for farro. And Giada's berry strata for dessert.

I'm not in college anymore, Dude.

Sorry, I didn't realize you were a girl. I take it back.

 

[RogueUnicorn]

Oh is daunting what I was getting at?

oh it wasn't?

 

[sideways]

oh it wasn't?

No bleargh, it wasn't.

 

[RogueUnicorn]

No bleargh, it wasn't.

what was it then

 

[sideways]

what was it then

Use that big brain of yours to give it another shot. Notice I said nothing about effort or cooking.

 

[RogueUnicorn]

Use that big brain of yours to give it another shot. Notice I said nothing about effort or cooking.

oh comma you must be a literalist. asperger's?

 

[sideways]

oh comma you must be a literalist. asperger's?

Community college psych?

 

[RogueUnicorn]

Community college psych?

english as a second language?

 

[sideways]

english as a second language?

You should donate so you can delete this fail comeback.

 

[RogueUnicorn]

You should donate so you can delete this fail comeback.

i try not to climb mt loan as high as you have.

 

[sideways]

i try not to climb mt loan as high as you have.

Fortunately nursing school isn't very expensive.

 

[RogueUnicorn]

Fortunately nursing school isn't very expensive.

neither is med school for some

 

[sideways]

neither is med school for some

You in Cuba brah?

 

[RogueUnicorn]

You in Cuba brah?

i have nothing now. which is convenient because i must be off.

 

[jboz]

 

[sideways]

 

[IndianVercetti]

For me, I don't like nursing and the whole approach. I am the wrong personality. It was almost insulting, some of the stuff they "taught" us. I did not like nursing school, I was always in trouble, and a good 70% of it was cr*p. I would not normally say this on this forum because I think it is worse to disparage another's profession, especially nursing, because it is easy to come off, especially if you are medically-oriented, as arrogant and mean. It does not go over well in interviews. It is just for ME that I can't handle nursing. I really tried my girl-scout best, but I was miserable. What is far WORSE to me, is Nursing theory. I would rather chew my leg off. What BS. I used to tell my mom (RN of 60+ years who felt the same way about my curriculum as I did, it was the "BS" part of the BSN.)

But... I LOVE great nurses. I am simply not nearly awesome or remarkable enough to be a good nurse. Maybe I am just not that compassionate, or maybe Im not such a great person.


But bedside nursing? No way. Care plans? WTF?

See, this is what I'm saying, I believe you are mirroring the sentiments of many in the medical profession, that the concept of "nurse" has changed over the years.

'Nurse' is defined as "One that serves as a nurturing or fostering influence or means." The concept of a nurse is integral to proper healthcare - to comfort the patient, provide for their needs, and serve as the patient's advocate. Physicians complement this role by provide the scientific medical treatment, but medicine as we know it would be far from ideal without the work of excellent nurses.

With that being said, there is a growing trend in nursing, as mirrored by your attitude of "mocking" the nursing profession saying it lacks scientific elements, or that Nursing Theory, and other humane-related courses are BS in today's world. This is not true in the least - it is absolutely imperative to have nurses, and your work is not ignored.

This is the another reason that I am troubled by a growing trend of nurses starting to 'reject' the notion of a traditional nursing curriculum, and try to achieve "DNPs" with the guise of saying they are merely 'enhancing their nursing education' when in fact they are drifting further and further from what it means to be a true nurse.

 

[45408]

I'm still waiting to hear examples. Do I need to invite you over for dinner? I'm making chicken breasts with raw puttanesca sauce with roasted capers, green salad, and grilled ciabatta. Bring Pinot Grigio and you're in.

Examples of what? specific nurses?

Here's the deal - there are some pretty sharp nurses, and those in ICUs tend to be pretty good. There are many settings for a nurse to work that requires fairly little CME, so a lot of the information learned in nursing school falls by the wayside in a hurry. Sure, if you say "Sudden drastic weight loss and jaundice," then many/most of them would know it was cancer, but the scenario posted was more subtle and involved doing an H&P, something that nurses aren't trained to do.

Clinic nurses, OR nurses, nursing home nurses, hospice nurses, school nurses, non-clinical nurses (like transplant coordinators, nurse managers, etc) are all in very focused settings that lend themselves towards forgetting a lot. I've heard this from nurses myself, especially with OR nurses.

 

[rama kandra]

I was paid to post this.

 

[mooshika]

...you were stupid like me and went to a fancy one.

Fortunately nursing school isn't very expensive.

 

[Nasrudin]

See, this is what I'm saying, I believe you are mirroring the sentiments of many in the medical profession, that the concept of "nurse" has changed over the years.

'Nurse' is defined as "One that serves as a nurturing or fostering influence or means." The concept of a nurse is integral to proper healthcare - to comfort the patient, provide for their needs, and serve as the patient's advocate. Physicians complement this role by provide the scientific medical treatment, but medicine as we know it would be far from ideal without the work of excellent nurses.

With that being said, there is a growing trend in nursing, as mirrored by your attitude of "mocking" the nursing profession saying it lacks scientific elements, or that Nursing Theory, and other humane-related courses are BS in today's world. This is not true in the least - it is absolutely imperative to have nurses, and your work is not ignored.

This is the another reason that I am troubled by a growing trend of nurses starting to 'reject' the notion of a traditional nursing curriculum, and try to achieve "DNPs" with the guise of saying they are merely 'enhancing their nursing education' when in fact they are drifting further and further from what it means to be a true nurse.

You're a thoughtful, even-headed guy. But you're like 20. How much time have you spent in a hospital of late. Not as a bystander. But was a worker. Because you don't get a feel for the politics unless you're part of the system. You don't sense the hierarchy as accutely because your living is not intrinsic to it.

Nurses haven't been "traditional" for a long time now. That's not to say I don't feel what you're saying. Many older nurses have said the same thing. That the new generation no longer values the traditional role. You're being troubled by it is...as if you were an enthusiastic archeologist...puzzling over the errors of Mayan civilization.

There's a schizophrenia of culture for sure. But Nursing curricula is quite dogmatic. It's sophistication for the inculcation of beliefs is quite impressive. The boon of having less responsibility for their actual knowledge base. So they come here to tell us exactly how scientific their training while simultaneously claiming how their patient centered hollistic philosophy is superior.

Like Moo. I would have flunked out. As I did from liberal arts. It's just to much bull**** to stomach.

I have worked immersed an aggressively unionized nursing environment for almost a decade.

Our diplomacy. Is futile. They've gone nuclear. And we can suck it, basically. Our forefathers exploitative sins have come home to roost.

 

[NH14]

So you assume us Vet students all just slacked off to get into vet school? We had to jump through pretty much all the same hoops you guys did.

Personally, I'm not sure why vets exist - just to prop up the pet industry? Oh, and make sure animals make it to slaughter? When animals are being fed and receiving medical care, human beings are starving and dying.

Ouch - that did come off a bit harsh - but come on...

 

[Perrotfish]

There's a schizophrenia of culture for sure. But Nursing curricula is quite dogmatic. It's sophistication for the inculcation of beliefs is quite impressive. The boon of having less responsibility for their actual knowledge base. So they come here to tell us exactly how scientific their training while simultaneously claiming how their patient centered hollistic philosophy is superior.

You know I honestly think that the 'holistic' thing might be more than just a buzzword in the case of nurses. There is a reasonable argument to be made that since a Nurse Practicioner can have 3x the apointment length as a physician they actually do get a chance to address the whole patient rather than just the chief complaint.

This is especially important in primary care for the elderly. When a patient comes in with a garbage bag of different medications and no cleaer idea of how to take them many FPs just don't have the time to wade through their entire medical history and to give them the kind of comprehensive care they deserve. You could argue that it's better for patients, particularly patients with comorbidities, to see a moderately educated practicioner for a long time than a highly educated practicioner for a short time.

Just a thought.

 

[45408]

Personally, I'm not sure why vets exist - just to prop up the pet industry? Oh, and make sure animals make it to slaughter? When animals are being fed and receiving medical care, human beings are starving and dying.

Ouch - that did come off a bit harsh - but come on...

Fewer human beings would be starving and dying if more animals were well cared for and could provide more food.

But really, if you're worried about the starving people in third world countries, you should go help them, not pick on veterinarians.

 

[rama kandra]

as kramer said - id take a vet over a md anyday. they have to cure a chicken a lizard a pig a horse, snap snap snap!

 

[IndianVercetti]

You're a thoughtful, even-headed guy. But you're like 20. How much time have you spent in a hospital of late. Not as a bystander. But was a worker. Because you don't get a feel for the politics unless you're part of the system. You don't sense the hierarchy as accutely because your living is not intrinsic to it.

Nurses haven't been "traditional" for a long time now. That's not to say I don't feel what you're saying. Many older nurses have said the same thing. That the new generation no longer values the traditional role. You're being troubled by it is...as if you were an enthusiastic archeologist...puzzling over the errors of Mayan civilization.

You're absolutely right, I haven't been an employee at a hospital, so please take that into account as you read my responses. However, I do feel I have done my research, and have spoken at great depth with hospital staff in relation to these issues.

I would disagree, however, that "most" nurses today have lost touch with what it means to be a true nurse. Most RNs, the ones I've observed in a hospital setting, and the ones I've talked to casually seem to take pride in caring for the patient as a human being, tending to their needs, communicating the patient's emotions to the physician, assisting the physician, and serving as a conduit to the family members needs. This breed of nurse still exists. As I stated earlier though, the development of this autonomous "medical-nursing" DNP degree may severely jeopardize the definition of nurse - creating a new nursing hierarchy where the traditional RN nurse is somehow second-standard to this DNP. This is entirely false, obviously, since the RN may actually be more representative of what it means to be a true nurse.

For whatever reason, it seems there is a belief among nurses that nursing is somehow a field that lacks respect. In many ways, this manifests itself with an inferiority complex, which is what I think is propelling the creation of the DNP.

 

[IndigoBoy0]

You're a thoughtful, even-headed guy. But you're like 20.

This is my problem with many of the posters on here. Lack of life experience. Sure they'll graduate school before the age that I have even started med school but they have no experience in the world minus cushy undergraduate education. Yes, I know this is the US, but everywehere else, we are training nurses to perform many of the same tasks as physicians and there is no issue because there is simply no other option. Go to Africa or Asia and see where women give birth without skilled attendants and I'd hope that you realize it doesn't matter who gives care in setting such as we're discussing with lack of healthcare (including the rural US which lack PC physicians) - as long as it's someone. Have you seen the outcome where there is no provider at all?? We are training people throughout the world, many who only have a primary education if that, to do many of the "doctor" tasks. The UN agencies, WHO, US government and many others support this effort.

Also, the DNP is a special breed. No, its not med school, but no its not 'normal' nursing either. There's additional training, additional studying, etc. As a soon to be med student, I can say that I would see someone who did not have a medical degree, if it meant that I would receive quality healthcare where no other option was available. Open your eyes - its all of our choices to study medicine. And if you can't deal with the fact that perhaps the degree you are pouring so much money and time into isn't as well respected as you thought and that other health providers can "threaten" your field perhaps you have joined the wrong profession. It's not like the DNP is performing surgery on me. Basic medical care is just that. Basic. If she can't treat it she'll refer me, just like lower level cadres do everywhere. If a community health volunteer in Malawi can diagnose preeclampsia and provide magnesium sulfate then so can a DNP in the US (mind you one of the articles said that DNP midwives had better birth outcomes than hopsital attended births anyways). I give my blessing. And who gives a damn if they call themselves doctor? As long as they're saving lives, have the correct training to do what they are doing, and allow more people to access health care?

Also, one will note that nursing school (at least a BSN) require many prerequisites that we are required to actually take in med school. I have many friends applying to nursing school and it is required that they take micrbiology, A&P, etc. So some of the things we do in the first two years they already had to do to get admitted. So we're not so special. Just some food for thought.

 

[IndianVercetti]

It's a shame we're judging our statements on age now. We're simply discussing differing perspectives, not critiquing each other.

 

[DVMDream]

Personally, I'm not sure why vets exist - just to prop up the pet industry? Oh, and make sure animals make it to slaughter? When animals are being fed and receiving medical care, human beings are starving and dying.

Ouch - that did come off a bit harsh - but come on...

I would like to see how quickly advancements in human medicine come about without veterinarians. All of those studies that get done in humans are usually done first in animals by veterinarians. Shocking, I know, but a vet is much more than the person that treats Fluffy. They also work in public health with zoonotic diseases (rabies, intestinal parasites, those flu virus strains that keep mutating). Without veterinarians medical advancements would become much, much slower. Dr. Tracey McNamara DVM was also the first to recognize the West Nile Virus outbreak in the US (started in wild bird species) after much studying, pathology and many, many tests.

 

[mfrizzo3]

Also, one will note that nursing school (at least a BSN) require many prerequisites that we are required to actually take in med school. I have many friends applying to nursing school and it is required that they take micrbiology, A&P, etc. So some of the things we do in the first two years they already had to do to get admitted. So we're not so special. Just some food for thought.

Undergrad A&P and Micro are not the same as their respective medical school classes. Not even close.

 

[45408]

I have many friends applying to nursing school and it is required that they take micrbiology, A&P, etc. So some of the things we do in the first two years they already had to do to get admitted. So we're not so special. Just some food for thought.

I took a fairly challenging biochem class in undergrad and did pretty well - got an A, steamrolled the final, and I got the 95th percentile on the ACS exam. We discussed the Krebs cycle for a week (three one hour lectures) and had to know the whole thing.

In med school (just a few months later actually), we covered the Krebs cycle again. In one hour, as one of 8 biochem lectures that week. The cumulative final was over a mind-boggling amount of material. I started studying for the final about 3.5 weeks before I took it, and it was still brutal (I think I got an 86 or so). At the med school pace, you could take nursing prereqs (or most any undergrad prereqs) in about 2 weeks.

 

[deleted191570]

Sorry, I didn't realize you were a girl. I take it back.

The ironic thing about this remark: Emeril is a man...

The right Path: I was actually going to tell you last night that no apologies were necessary, but I'd take any offerings by way of food... haha. Didn't think it was very relevant/appropriate for SDN. But now I regret it-- I'm clueless in the art of cooking.

 

[deleted191570]

I'll save you all the conversation and tell you why this is happening.

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

Obviously from the numbers a lot of med students only care about enriching themselves. If med students truly cared about helping people they would fill ALL primary care residencies because this is essentially one of the main the "frontlines" of health care. THIS IS NOT THE CASE. Most of that junk pre-meds say on their PS is bogus anyway, just to get in. At my university I've worked under several professors who teach in med school pre-rec's and they all have said the same thing to me. It's just recycled junk that adcoms hear every year. If any were smart they would present themselves in a different and unique manner. We live in a world of greed. I commend both Nurses and EMT's for doing the dirty work ( literally) for much lesser pay. These are the individuals who TRULY CARE and they should not be disrespected.

Your assumption is that EMTs & Nurses do the dirty work for lesser pay because they truly care, & most doctors do what they do because they don't. Care to back up your assumptions? I can think of more than a few flaws with your thinking.

You will realize real quick once you enter med school & get your first interest statement, that becoming a physician is a very inefficient way to make good money, especially in these uncertain times.

It might be inefficient (in the short run), but most likely you will make money.

Also, it's not all about the $$. There is great job security for physicians. And you will have an ability to contribute in absolutely any community, anywhere in the world.

People are greedy, but I think this is overstated as a reason why med students don't enter primary care from med school. There's a whole laundry list of other reasons, and personally, I think $$ is just the brick that breaks the camel's back.

 

[The right Path]

Examples of what? specific nurses?

Here's the deal - there are some pretty sharp nurses, and those in ICUs tend to be pretty good. There are many settings for a nurse to work that requires fairly little CME, so a lot of the information learned in nursing school falls by the wayside in a hurry. Sure, if you say "Sudden drastic weight loss and jaundice," then many/most of them would know it was cancer, but the scenario posted was more subtle and involved doing an H&P, something that nurses aren't trained to do.

Clinic nurses, OR nurses, nursing home nurses, hospice nurses, school nurses, non-clinical nurses (like transplant coordinators, nurse managers, etc) are all in very focused settings that lend themselves towards forgetting a lot. I've heard this from nurses myself, especially with OR nurses.

Well, yeah, I was expecting a specific example to illustrate your point. Is it really that difficult to recall?

The amount of continuing ed is set by the state's board of nursing. For California (which is the only place I've ever practiced nursing)- to maintain an active license whether you're the CEO, or bedside scuteroo, or school nurse the continuing ed requirements are 30 hours/2 years. Certain specialty certifications have different requirements- maybe that's what you're referring to? To maintain my critical care certification status, I have to do 100h/3 years so that automatically covers my state requirements, but in all honesty the extra continuing ed does not necessarily make me a better, or smarter nurse. Passing the CCRN test, however, does demonstrate a specialized knowledge set that pertains to a particular population of patients.

Regarding the scenario....No one should presume that sudden drastic weight loss + jaundice = cancer, either. It's a possibility, but more work up needs to be done for definitive diagnosis. Which is not a bedside RN's role, either, but a bedside RN should be aware that those signs/symptoms are indicative of anything from a hematologic pathology to hepatic pathology. An RN should be able to anticipate what futher tests would be done, and have at least a basic understanding of what the results mean and what treatments are expected, what outcomes are hoped for, what adverse effects/complications to be aware of, and to be able to gauge how well, or not the patient is responding to the therapy. A nurse's degree of skill and sophistication in this process will vary depending on quality of education, experience, and dedication, etc. Yes, nursing involves more than pill passing, ass wiping and reassuring pats. Who knew?

When there is an obvious breakdown of the standard of practice such as I described, yeah, that is a problem. It should be an exception and it should be addressed. That is why I'm curious about the particulars of the obvious insufficiencies that you've experienced.

I'm not trying to pick on everything you say, but you should know that nurses are taught how to obtain a patient history and of course, perform physical assessment. It's actually not rocket science, but it is an important interpersonal skill (for physicians and nurses). Developing a rapport, building trust, making your patient comfortable, asking the right questions in the right way.

And you are absolutely right about forgetting information that is rarely used. That's true for anybody in any profession. That's where continuing ed can be of real use. It's the reason why ACLS/BLS has to be renewed every 2 years, we get the KCI rep to do an inservice when we have a Rotoprone bed, etc. It's why I don't float to L&D or peds despite having done rotations in those areas in nursing school. Of course a person has to have specialty/area of practice related competency.

 

[Nasrudin]

It's a shame we're judging our statements on age now. We're simply discussing differing perspectives, not critiquing each other.

Hey man. Look. You're maturity has nothing to do with your age. You're cool headedness will serve you well. But it would be impossible for you to have seen the darker underbelly of our health care system's largest group w/out having either worked under them or with them as a medical student.

Any 3rd or 4th year gets well acquainted with this on day 1 of rotation one. As pristine white coats attract the blood lust of battle axes everywhere.

From a different angle. As their former scut monkey. I too am not fooled by their political double speak. And pay much closer attention to the facts of their body politic.

If for no other reason than to better understand the obscene course of this middle steering behemoth. For my own sake.

If that makes me a greedy bastard to some of these plebes I care not.

 

[The right Path]

Like Moo. I would have flunked out. As I did from liberal arts. It's just to much bull**** to stomach.

I have worked immersed an aggressively unionized nursing environment for almost a decade.

Our diplomacy. Is futile. They've gone nuclear. And we can suck it, basically. Our forefathers exploitative sins have come home to roost.

Love ya, Nas. Darn what was that line from "A Christmas Story?" Something along the lines of, "my father worked in swear words like Picasso worked in paint".... You're like that, except not with swear words, but so picturesque, enigmatic, incorporeal, yet so on point.

I almost want to try out a week in your unit. (I've only worked in one hospital since nursing school (2004) and nursing there is not union. I want to meet these nazi union nurses you work with. I've actually considered whoring myself out to Kaiser per diem should I find myself short on post-bacc funding. Would that be close enough?

I think just about all of us that have had Calista Roy and the like foisted on us in nursing school are left scratching our heads for a moment before settling into our favorite *ahem* daydream until class is over. Thankfully, it's just a small portion of the curriculum and it's well over and done with by the time we hit the real world.

You know I honestly think that the 'holistic' thing might be more than just a buzzword in the case of nurses. There is a reasonable argument to be made that since a Nurse Practicioner can have 3x the apointment length as a physician they actually do get a chance to address the whole patient rather than just the chief complaint.

This is especially important in primary care for the elderly. When a patient comes in with a garbage bag of different medications and no cleaer idea of how to take them many FPs just don't have the time to wade through their entire medical history and to give them the kind of comprehensive care they deserve. You could argue that it's better for patients, particularly patients with comorbidities, to see a moderately educated practicioner for a long time than a highly educated practicioner for a short time.

Just a thought.

I definitely wouldn't claim that nurses have a monopoly on "holistic" care. Of course patients are more, and sometimes oh, so much more than the sum of their parts. The way that healthcare has been reimbursed is part of the reason there is so much pressure to squeeze so many patients into the working day. I distinctly remember (from my days working as a medical assistant while in college) that the MediCal's reimbursement for an office visit was $16. Yeah, no wonder no one wanted to take care of these patients. Sucks to be the doctor practicing in an area in which the majority of the population that even has healthcare coverage has MediCal. Anyway, I'm starting to digress...

You're absolutely right, I haven't been an employee at a hospital, so please take that into account as you read my responses. However, I do feel I have done my research, and have spoken at great depth with hospital staff in relation to these issues.

I would disagree, however, that "most" nurses today have lost touch with what it means to be a true nurse. That's an interesting statement, I'm curious to hear why you think this is the case. I'm a little more perplexed by your next sentence in which I'm guessing is your description of qualities of a "true nurse". How can "most" of the nurses you have observed fit this description, yet "most nurses today have lost what it means to be a true nurse" ? I'm not trying to be nitpicky, I'm just trying to figure out what I'm missing here. Most RNs, the ones I've observed in a hospital setting, and the ones I've talked to casually seem to take pride in caring for the patient as a human being, tending to their needs, Well of course. One would hope that would be a given. We are after all taking care of people, not objects. communicating the patient's emotions to the physician this statement comes across as a little silly (not trying to be mean)- but really physicians can figure that out on their own during their rounds. Physicians generally don't ask us how Mrs. X is doing (in terms of being happy, sad, scared, etc.) and should that sort of thing be volunteered, it would be met with a response ranging from "that's nice" to "what's your point?" It only warrants a call to the physician when a patients emotional/behavioral response is newly out of proportion with the situation and/or resulting in an unsafe situation requiring pharmacologic and/or restraint-type intervention., assisting the physician This varies greatly by setting, but in my unit (ICU/NSICU), we rarely do any actual "assisting". Physicians make their rounds, assess (maybe) the patient, write orders (or not), and may or may not discuss the patient at all with the RN. I'm not saying it's good or bad, it's just how it is. Actual assisting generally only applies to the actual performance of procedures, such as central line placement, ventriculostomy insertion, intubation, etc. which is a small percentage of what goes on- if at all., and serving as a conduit to the family members needs. This is a big hell yes. Sometimes to the point in which the family monopolizes way too much time that it actually becomes an interference. But of course our care is by nature patient and family centered. This breed of nurse still exists. As I stated earlier though, the development of this autonomous "medical-nursing" DNP degree may severely jeopardize the definition of nurse (How is a DNP in opposition to your description of nursing as stated above?)- creating a new nursing hierarchy where the traditional RN nurse is somehow second-standard to this DNP. This is entirely false, obviously, since the RN may actually be more representative of what it means to be a true nurse.

I wanted to include some further insight into what "nursing" really is- at least from the particulars of where I practice. Starting at the beginning of the shift, actually usually a little earlier, I start jotting down relevant information about my patient from the Kardex and from the electronic records and of course from the offgoing RNs report. Basically, I have 30 minutes to get what I need to know for my one or two patients, plus do joint neuro assessments (when needed) plus double check certain medicated drips, do the chart check and med list check (with the offgoing RN). Then next I need to completely assess both patients, addressing physiologic problems, pain/anxiety issues, psychsocial issues, family issues, giving whatever medication needs to be given, documenting everything (which is fairly burdensome). It's actually a continual process. In order to give safe, let alone effective care, I have to understand what is wrong with the patient, what treatment is appropriate, what outcomes are trying to be acheived, what adverse affects/complications to prevent and be vigillant for, what further diagnostic or therapeutic interventions are anticipated, etc. I also need to make sure that the patients' hygiene needs are met, that they are repositioned q 2 h, that they don't pull out any of their invasive equipment, or fall out of bed. I have to teach them about their medications, therapies, etc and document it. I have to ensure that everything is compliant with policy and Joint Commission standards. It's really a helluva lot of responsiblity with a ton of demands that need to be prioritized. Nurses are actually quite autonomous and need to be able to recognize and respond to problems independently- knowing when and when it is not appropriate to notify the physician (and which one, at that). Most times when I need to call, I am asking for a specific intervention and the physician agrees. This is not to say I consider my knowledge/skills equal to a physician. The quality of nursing care truly can make or break how well a patient can recover. The patient is at the mercy, so to speak, of one nurse (with little if any physician or other discipline face time) for 8-12 hours. That's why quality of nursing care is so important. Nursing is definitely not the career for everybody. It is physically, mentally, and emotionally taxing, but at the same time incredibly rewarding.

Wow, long winded, sorry. I hope it helps you in some way, though.

For whatever reason, it seems there is a belief among nurses that nursing is somehow a field that lacks respect. In many ways, this manifests itself with an inferiority complex, which is what I think is propelling the creation of the DNP.

I disagree that for the majority of nurses, that the motive behind the DNP movement is respect, or lack thereof. In this day and age of the "entitlement attitude" you'll see that patients/families don't treat physicians with much if any more respect than nurses. Nurses may have to deal with it more, however, since they can't get away from the bedside like the physician can. For whatever public opinion polls are worth, nurses score higher than physicians in honesty and ethics.

Anyways, generally speaking, the motive for seeking advance practice education is the desire to be able to "do more" for their patients without losing their nursing identity. Yes, yes.... so the logical question is, "why don't you go to med school, then?" Well, apparently, the line of thinking is that nurses (with advance practice education) can provide care that is just as good as that of a physician within certain parameters (which also need clear definition). <-----So that is the premise that needs to be thoroughly examined.

If this premise has proven to be true (some argue that it has, others argue that it hasn't), then the role of the traditionally medically educated provider isn't obsolete, but maybe needs to evolve.

Healthcare and healthcare delivery do need to evolve to meet the changing needs, changing technology, and increasing complexity of the population, does it not?

I currently do not have an opinion on the efficacy, safety, etc. of midlevel providers. Nor do I have an opinion on what are appropriate boundaries of practice. I am open to their establishing their role in healthcare- so long as safety and efficacy is adequately demonstrated. Assumptions, no matter how passionately held are just assumptions until they are tested.

I bolded and added some commentary to your post.

They just don't get it. Never will either, unless they do it themselves.

All my relatives ask me if I enjoy medical school. They look at me cross-eyed when I tell them I hate it. It's soul-sucking.

I promise to post my insights on medical education/training once I get there. It'll be a 'lil while, I'm planning to start my post-bacc work Fall 2011.