Every patient deserves an RN.. Oh the hypocrisy..

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Do you think everyone working in ACT model is truly greedy? I mean, really, I get the principle you are trying to convey but sometimes this sub turns into virtue signalling so fast. Do you really think there are a lot of anesthesiologists behaving the way you describe? I haven't been to as many ORs as you I'm quite sure but this statement is akin to saying most poor people don't want to work and provide for their families.
Ok, firstly he/she didn’t say everyone working in an ACT is greedy. Plenty of people have no option and plenty of others hate being stool sitters.

Secondly, yes, there are PLENTY of anesthesiologists and other docs who use mid levels inappropriately in order to make a bunch of money off them. Plenty. It’s all about the money for them.

If you work in multiple practice settings over your career you will see it. The greed is real my friend. Just open your eyes.

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Ok, firstly he/she didn’t say everyone working in an ACT is greedy. Plenty of people have no option and plenty of others hate being stool sitters.

Secondly, yes, there are PLENTY of anesthesiologists and other docs who use mid levels inappropriately in order to make a bunch of money off them. Plenty. It’s all about the money for them.

If you work in multiple practice settings over your career you will see it. The greed is real my friend. Just open your eyes.
I didn't say that he said that everyone in ACT is greedy previously. Hence, I phrased it as a question. I want to understand his perspective so I can better understand his post because I can't tell if he is disagreeing with the poster he quoted or responding tangentially.

I'm well aware there are many greedy people. I'm not oblivious to that or denying it. That said, inappropriate has varying definitions even in this forum. I've read your multiple, lengthy arguments about not allowing an MD anesthetic at request in an ACT practice for example LOL.

Does he think a busy ACT doc who lets midlevels do chipshot epidurals are lazy and greedy? I'm asking what HE thinks constitutes inappropriate.
 
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He was prob terrible to begin with


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Life happens. We all get old. Some of the old fart behind the times attendings who suffer from skill atrophy were A-players in residency and for many years as attendings.

You and your contemporaries too will get old. Some will age well and adapt their practice wind down their careers gracefully. Some will do the opposite.
 
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I don't know, Ive been around quite a few years and I get paid the same amount whether I sit on the stool for endless hours and transport patients than i do supervising Mid Level nurses. IN fact Ive never been to a practice that the Anesthesiologists profitted personally for supervising nurses.. Maybe the practice owner, hospital CEO, AMC shareholders make money but not the Anesthesiologist per se. Does that make it ok? It is ok for the shareholders to be greedy who never stepped foot in a hospital but the ANesthesiologist who are actually assuming liability for the whole thing?
As far as I know, if you are supervising you split the fee 50:50 with the CRNA anyhow..
 
There are plenty of docs on this board and everywhere making tons of money off supervising nurses.
I hear though that you gotta consistently do it at a 1:4 ratio in order to make it work in your favor.
No Thank You.
I will take my 400 to 500 instead. Don’t need 600k+. Not if I gotta sell my soul.
 
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Since I mentioned how bad computers are at reading EKGs (false negatives), here are some examples

Never trust a "normal" EKG read, especially if the patient has suggestive symptoms.
A couple of those were REALLY discreet, and alone (without symptoms) I would have never thought twice about them (like patient number 2 for example).
 
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That’s exactly what my mentor told me. He said there is research going on now to use AI to be able to analyze things like lung tumors and be able to determine which type of cancer it is based on the mass and how it responds to the imaging modality.
That's the hope. Make AI an ally and not the enemy but it is slippery footing as history has taught us. I really thought anesthesia had more time though, at least for one last generation to cash out. Maybe it still does. I really didn't see this pandemic coming. Nor that midlevels would jump on the opportunity to use it to push their agenda. Give them an A for exploitation and ingenuity.
 
That's the hope. Make AI an ally and not the enemy but it is slippery footing as history has taught us. I really thought anesthesia had more time though, at least for one last generation to cash out. Maybe it still does. I really didn't see this pandemic coming. Nor that midlevels would jump on the opportunity to use it to push their agenda. Give them an A for exploitation and ingenuity.

Doesn’t surprise me at all. People can be extremely selfish and exploitative.
 
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ICU RN here. It is funny how much the nursing schools try to "brainwash" us into thinking we're basically doctors (lol) but I can understand it. Most of the effective nursing interventions are low-tech and unsexy - Q2H turns, oral care, pulmonary care, patient/family education, etc. Supporting the patient's body as he or she recovers. Making sure the basics are done well, every single shift. But it's hard to sell $60k in student debt when that's the career you're pitching.
 
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@Fart Daddy Smooth I’m so upset that you thought of that username before me

Edit: Didn't catch that you were an RN... I suppose as a doctor, I should pretend that the username was my idea :p
 
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2 chicks at the same time??
OT
Salty, I don't know why, exactly, but I thought of you and your great humor when I saw this posted by a friend. Too funny!
ab268f0232d56ebe394fbf72bb0b57348909f2f2fd91814084e723db32b5e3b9.jpg
 
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A couple of those were REALLY discreet, and alone (without symptoms) I would have never thought twice about them (like patient number 2 for example).
Without looking at the explanation, #2 jumps out because of the tall T's in III, aVF and V2, flipped T in aVL, that huge jump in R from V2 to V3, the P wave that's buried at the end of some T's (a U wave would be taller than the T, 2:1 block?).

Now let's see what I missed, after I post this message.

P.S.
Interesting, they call it a negative U wave (I wouldn't), hence no block, and some minor differences, but otherwise not bad for an intensivist who rarely sees angina. :D

Anyway, the lesson I learned in the ICU, long time ago, was to trust the patient, not the machines. If there is chest pain, there is trouble, more likely than not.
 
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Not hard to sell, if the salary is 80 bucks an hour and more..

Hey, if that's for an RN position let me know if they are hiring. I'm in a union at a large academic hospital in the Midwest and we top out at around $60/hr base pay after 264 months. Not bad for a bachelor's degree, sure, but the only positions I know that approach $80+/hr are CRNAs.
 
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- Q2H turns, oral care, pulmonary care, patient/family education, etc. Supporting the patient's body as he or she recovers. Making sure the basics are done well, every single shift. But it's hard to sell $60k in student debt when that's the career you're pitching

Skilled icu nurse is one of the single most important, if not most in the icu. Those small interventions with turning to prevent decub and oral care to prevent Aspiration matter.

You can be a brilliant Intensivist, but if orders are missed and that small stuff turns into big stuff. That's the problem now, noises stuck in books for app school or studying to get into crna school instead of being a good icu nurse.
 
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I don’t think it’s an intelligence thing at all. However, the AANA has already set precedent and been pushing for independent practice of nurse anesthetists while I don’t see anything near that kind of threat for radiology. Are there radiologists out there overseeing 4 nurses who read CTs and MRI? Is there a nursing lobby out there pushing the idea that NPs have equal or better training than radiologists?

Like I said, I don’t think it’s about intelligence at all and I’m sure some radiologists are training NPs hoping to make the extra buck, but there’s no strong lobby backing independent NP or PA radiologists and would a physician trust a read from an NP or PA radiologic-mid level?
Not in the near future...
 
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Not in the near future...
I spent 2 months in pulm-CC with occasional interaction with a few experienced midlevels. Even in an imaging heavy field with only one body area imaged, the interpretations they made were horrendous and they couldn't even use the words correctly. These are the people who should be best at their particular imaging area. I'm not worried at all about midlevels interpreting radiology. None of them can even speak the language. The attendings would just laugh at how bad it was.
 
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Who? I haven’t done a formal study, but I have informally talked to people about it and I have yet to talk to someone who would be okay with AI reading their images without collaborating with a radiologist if at all.
The nearer term risk to diagnostic radiology is that it can be done remotely. When the bulk of reads can be piped to a basement full of radiologists in a lower cost of living area (not necessarily even offshore) there will be more and more pressure on radiologists. Throw in new computer tools to assist those radiologists and improve throughput, and fewer will be needed in the first place. We're not far off the point where a radiologist will be able to rapidly "review" and rubberstamp a machine read in a safe enough manner, and if both the machine and he miss something, that's where insurance comes in.

Longer term - and I'll concede this might not be an issue for people entering the field today - but it's just whistling past the graveyard to think AI reads won't be better than people at some point, and to think that the Formula from Fight Club won't be applied to cost and risk decisions in medicine.

It's not just raw processing power and clock speed, although those are enabling technologies. It's better algorithms and especially machine learning, which is still in its infancy despite the amazing things it's already doing. We're at the point where computers are far, far superior to humans at games like chess and go. What's important there, and not widely appreciated, is that ceding those games to the machines hasn't come about because of Moore's Law. Humans don't understand how the machines are coming up with their moves. I play chess at a moderately high level, and make a somewhat serious study of the game, and machine moves are just mysterious. Grandmasters struggle to understand some of their positional moves, material sacrifices, they way they seem to ignore obvious threats, at least until after the fact. We didn't teach them ideas, or principles, or patterns. They're just better than we are, they "see" more, miss nothing.

The branches of interventional radiology seem much safer, like most fields that need a proceduralist to touch and invade a patient's body. Sitting at a computer terminal though, converting 1s and 0s on the input side into 0s and 1s on the output side? There'll come a day when that's a waste of oxygen. During my lifetime, certainly ... during my career, perhaps not.
 
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The nearer term risk to diagnostic radiology is that it can be done remotely. When the bulk of reads can be piped to a basement full of radiologists in a lower cost of living area (not necessarily even offshore) there will be more and more pressure on radiologists. Throw in new computer tools to assist those radiologists and improve throughput, and fewer will be needed in the first place. We're not far off the point where a radiologist will be able to rapidly "review" and rubberstamp a machine read in a safe enough manner, and if both the machine and he miss something, that's where insurance comes in.
Doesn't the military do this at baseline these days?
 
Doesn't the military do this at baseline these days?
At my large military hospital we still have radiologists (and residents) in house. I don't know how much they ever farm out, or if our radiologists are set up to read from home. I know they do reads for some of the smaller surrounding military clinics. We have teleradiology capabilities but I'm honestly not sure how often that gets used at great distances, e.g. by our overseas and ship-based units that don't have radiologists. For the forward surgical team I'm attached to now we have plain film capability but they're just read by us (gen surg, ortho surg, EM, anesthesia) and it's not like the things we're looking for are subtle.
 
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At my large military hospital we still have radiologists (and residents) in house. I don't know how much they ever farm out, or if our radiologists are set up to read from home. I know they do reads for some of the smaller surrounding military clinics. We have teleradiology capabilities but I'm honestly not sure how often that gets used at great distances, e.g. by our overseas and ship-based units that don't have radiologists. For the forward surgical team I'm attached to now we have plain film capability but they're just read by us (gen surg, ortho surg, EM, anesthesia) and it's not like the things we're looking for are subtle.
Thanks for the reply. I have a friend in residency in one of the branches, knew some studies were pushed to where they are currently stationed but didn't know how extensive this is operationally.
 
ICU RN here. It is funny how much the nursing schools try to "brainwash" us into thinking we're basically doctors (lol) but I can understand it. Most of the effective nursing interventions are low-tech and unsexy - Q2H turns, oral care, pulmonary care, patient/family education, etc. Supporting the patient's body as he or she recovers. Making sure the basics are done well, every single shift. But it's hard to sell $60k in student debt when that's the career you're pitching.
Do they teach all this brainwashing in bachelor RN programs?
Thought it happened in graduate school.
 
Do they teach all this brainwashing in bachelor RN programs?
Thought it happened in graduate school.

A friend of mine was a RN before medical school. He told me the general idea they pushed while he was in school was “you’re here to fix what the doctor ****s up.”
 
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Do they teach all this brainwashing in bachelor RN programs?
Thought it happened in graduate school.

Lots of talk about how NPs were gonna be replacing doctors, stuff like that. Presentations on medical errors committed by physicians and how we were the "final safety check" between a careless physician and the patient. Divisive stuff like that. Just seemed like everyone at the school had kind of a chip on their shoulder, which in turn got transferred to us.

It's important to develop confident nurses that will feel comfortable questioning a physician's order, but instilling division between our disciplines from the outset is not the way to do that.
 
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Lots of talk about how NPs were gonna be replacing doctors, stuff like that. Presentations on medical errors committed by physicians and how we were the "final safety check" between a careless physician and the patient. Divisive stuff like that. Just seemed like everyone at the school had kind of a chip on their shoulder, which in turn got transferred to us.

It's important to develop confident nurses that will feel comfortable questioning a physician's order, but instilling division between our disciplines from the outset is not the way to do that.
Wow. Seriously? Wow.
 
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Skilled icu nurse is one of the single most important, if not most in the icu. Those small interventions with turning to prevent decub and oral care to prevent Aspiration matter.

You can be a brilliant Intensivist, but if orders are missed and that small stuff turns into big stuff. That's the problem now, noises stuck in books for app school or studying to get into crna school instead of being a good icu nurse.

Yes, 100%. It's fun to ooh and ahh over the latest gizmos but the simple stuff is still the most efficacious and cost effective interventions we have! Early mobilization, sedation vacations, turns, oral care, pulling foleys/CVCs, pulmonary toilet. Making sure your patient and their family has an understanding of what's going on. All the basic stuff. It's not sexy but it might be the most important thing we can do.

Wow. Seriously? Wow.

Yes. I'm probably overstating it, but there was definitely a consistent undertone of "nurses are basically doctors".

I wish nursing schools would approach it as an entirely separate discipline, kind of like physical therapists or RTs, instead of a doctor-lite thing as so many seem to do. Just instills an inferiority complex in us that many do not seem to overcome.
 
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What are y'all gonna do about it? Medicine seems to be all talk whilst nurses and other healthcare workers unionize and get support from different levels of legislative authority. Physicians are just being screwed over by admins (we can't even stand up for ourselves) and soon by other professionals. We just eat our young.
 
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Yes, 100%. It's fun to ooh and ahh over the latest gizmos but the simple stuff is still the most efficacious and cost effective interventions we have! Early mobilization, sedation vacations, turns, oral care, pulling foleys/CVCs, pulmonary toilet. Making sure your patient and their family has an understanding of what's going on. All the basic stuff. It's not sexy but it might be the most important thing we can do.



Yes. I'm probably overstating it, but there was definitely a consistent undertone of "nurses are basically doctors".

I wish nursing schools would approach it as an entirely separate discipline, kind of like physical therapists or RTs, instead of a doctor-lite thing as so many seem to do. Just instills an inferiority complex in us that many do not seem to overcome.

Self disclosure here: I am (was ) a RN.

I don't think you are overstating it... The nursing profession mantra is: We are different but equal or better than doctors. "We are the patient advocate." is the favorite sentence of every nursing school professor. It implies that nurses are there to protect patients from doctors.
 
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When I was considering nursing prior to med school, an RN told me she didn’t think I could handle it because it’s “basically med school in two years”. She seriously told me to go to medical school because she thinks it’s easier. I’ve met multiple RNs from different schools who say their schools tell them the same thing.
 
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When I was considering nursing prior to med school, an RN told me she didn’t think I could handle it because it’s “basically med school in two years”. She seriously told me to go to medical school because she thinks it’s easier. I’ve met multiple RNs from different schools who say their schools tell them the same thing.

I’ve heard PA students say that **** too.

The worst I’ve heard, was a naturopath student say they push them way harder than medical students because they’re the underdogs.
 
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Nurse anesthetist here, just had to google naturopath, found this. Had a giggle, here you go.
I’ve heard PA students say that **** too.

The worst I’ve heard, was a naturopath student say they push them way harder than medical students because they’re the underdogs.
Zissou, where did you meet this creature?
Screenshot_20200506_230210.jpeg


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Nurse anesthetist here, just had to google naturopath, found this. Had a giggle, here you go. Zissou, where did you meet this creature?

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Funny enough, I’ve met quite a few. My significant other did her undergrad at a school that also has a naturopath program. Most of them are crazy AF, pie in the sky, narcissists. But some of them are really nice people who believe some things that are....out there to say the least.

One of them used to put their crystals out on top of the dorm roof. They did it so they could, you know, recharge their healing crystals.
 
Do you think everyone working in ACT model is truly greedy? I mean, really, I get the principle you are trying to convey but sometimes this sub turns into virtue signalling so fast. Do you really think there are a lot of anesthesiologists behaving the way you describe? I haven't been to as many ORs as you I'm quite sure but this statement is akin to saying most poor people don't want to work and provide for their families.

Everyone working for an ACT model isn't greedy, but the ACT model was borne out of greed (and laziness).

I didn't say that he said that everyone in ACT is greedy previously. Hence, I phrased it as a question. I want to understand his perspective so I can better understand his post because I can't tell if he is disagreeing with the poster he quoted or responding tangentially.

I'm well aware there are many greedy people. I'm not oblivious to that or denying it. That said, inappropriate has varying definitions even in this forum. I've read your multiple, lengthy arguments about not allowing an MD anesthetic at request in an ACT practice for example LOL.

Does he think a busy ACT doc who lets midlevels do chipshot epidurals are lazy and greedy? I'm asking what HE thinks constitutes inappropriate.

The poster I was replying to was making a statement that physician extenders should be used as the supervising physician sees fit - that each midlevel should be individually evaluated and be allowed to practice within that scope. The point I am making is that there are plenty of anesthesiologists who will use that as justification for letting CRNAs run completely wild, acting autonomously for all intents and purposes, while they sit on their haunches doing jacksh*t. There should absolutely be limits to what midlevels can do, and the boundaries should be very clear. Leaving it up to the discretion of supervising physicians is a slippery slope since there are always bad apples that will ruin it for everyone else.

Of course, we are well past the point of no return now, so it's a moot point. But as @chocomorsel and @2.0% mentioned, leaving it up to physicians is what got us into this mess to begin with.
 
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There should absolutely be limits to what midlevels can do, and the boundaries should be very clear. Leaving it up to the discretion of supervising physicians is a slippery slope since there are always bad apples that will ruin it for everyone else.

Agreed. I feel that having defined limits is necessary to prevent or discourage letting them run rampant, BUT it should be accepted across the board that the supervising physician can determine whether a particular mid-level is competent enough to practice to that limit. Unfortunately, all the midlevels talk about is practicing at the "top of their license," when in reality, only the most experienced and capable of midlevels should be allowed to practice at that limit (which still should involve physician supervision). They turn a blind eye to the fact that every mid-level is not on the same level or capability.
 
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Agreed. I feel that having defined limits is necessary to prevent or discourage letting them run rampant, BUT it should be accepted across the board that the supervising physician can determine whether a particular mid-level is competent enough to practice to that limit. Unfortunately, all the midlevels talk about is practicing at the "top of their license," when in reality, only the most experienced and capable of midlevels should be allowed to practice at that limit (which still should involve physician supervision). They turn a blind eye to the fact that every mid-level is not on the same level or capability.
The top of a hill is still nothing like a mountain.
 
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Agreed. I feel that having defined limits is necessary to prevent or discourage letting them run rampant, BUT it should be accepted across the board that the supervising physician can determine whether a particular mid-level is competent enough to practice to that limit. Unfortunately, all the midlevels talk about is practicing at the "top of their license," when in reality, only the most experienced and capable of midlevels should be allowed to practice at that limit (which still should involve physician supervision). They turn a blind eye to the fact that every mid-level is not on the same level or capability.

The most capable and experienced midlevels who can do their job with their eyes closed never talk about practicing “at the top of their license.” The reason they’re so capable is because they’ve been learning and collaborating with physicians for decades.
 
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The most capable and experienced midlevels who can do their job with their eyes closed never talk about practicing “at the top of their license.” The reason they’re so capable is because they’ve been learning and collaborating with physicians for decades.
Or maybe they just never talk in public. ;)

Most people suffer of Dunning-Kruger. The grapes will always be sour. Human nature.
 
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The most capable and experienced midlevels who can do their job with their eyes closed never talk about practicing “at the top of their license.” The reason they’re so capable is because they’ve been learning and collaborating with physicians for decades.
"collaborating"
 
Well, they figure out if they say it all the time, physicians and the public will start adopting their language.
I correct recruiters when they use that word to describe jobs
 
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1. to work, one with another; cooperate, as on a literary work.

2. to cooperate, usually willingly, with an enemy nation, especially with an enemy occupying one's country.

#1 is what they mean to convey. #2 is what it feels like.
 
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