Holy poo! Hate for midlevels.

[f_w]

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Nothing is funnier than nurses going at each others throats over what they are and what they do. This thread started out about lack of respect for midlevels, it has taken an interesting turn to showcase the infighting of the nursing profession.

 

[fab4fan]

I have a thought a little about your posts on this thread Jane. And honestly, I disagree with the basic tone of them.

I have worked med/surg for many years then I went on to become an NP in geriatrics (although I am often in the hospital since so many of our residents end up in medical of course). I really love being a nurse. I do not see my job as being the 'eyes and ears' for the physician. I do indeed think that implies a subordinate role. And this is the issue with nurses world wide.

In California nurses have a very strong voice, and have worked hard for autonomy in their setting. Of course we have a scope of practice. Naturally there are things we cannot do without a physician's order.

HOWEVER, in the eyes of the public the stereotypical subservient handmaiden's role is what they think of when they see a nurse. THAT is why a person of your talents, experience and education gets little more than a teenager at McDonald's.

Here are the conditions for nurses in California http://www.calnurses.org/membership/model-contracts/

As you say, you admit patients and the doctor gives orders based on your assessment. That is huge, and it happens all the time. Why on earth are you getting paid a fraction of their wage then? How many patients have you saved because you are front line and alerted the physician about the condition, who then acted upon it? If you did not have a very good idea of what was happening and what needed to be done, you would not have known to make the call. In many cases the phone call is a formality. And you know as well as I that if I did not have a good idea of what to do and suggestions to make to the doc when I call, I would be delinquent in my duty (and the doc would wonder if I really knew what I was doing or not).

We do not merely 'report' we also advise. We advocate. We tell the physicians what we think, and they are happy to hear it. We act on behalf of the patient, we double check the physician's work. And that is something that most people do not know that nurses do.


Unless nurses start standing up and making the public know what they do, they will continue to work for peanuts.
Doctors, REAL doctors, already know. But the ignorance on this board alone is representative of the public ignorance and that must change.🙂

Excuse me, but I think you are the one with the skewed understanding of what autonomy means. At the very least, do you need to belittle one of your nursing peers merely because she disagrees with your perspective?

As far as the CNA, I happen to be a card carrying member and proud of it. Are you? What kind of advocacy programs have you personally gotten involved with? I was part of a forum for universal health care last month in my state. Next week I'm going to a conference sponsored by the CNA on patient advocacy.

Stereotypes take a long time to break down. It's going to take time for people to see nurses as more than handmaidens. For every patient who thanks me for the good care I've given him, I've got another asking me to get him and his wife "two coffees, cream, no sugar." For every doctor who treats me with respect and listens to my assessment of a situation, there's another who will brush me off. I do the best I can. I'm not "just a nurse," but I don't have any illusions to being more than a nurse, either. FWIW, I hardly think being trusted to be the "eyes and ears" of the physician is a lowly role. I always thought it was a pretty responsible position.

Frankly, horsenurse, your tone disappointed me, and it's attitudes like yours that turn me off from going further into nursing. It's that ivory-tower, scornful view of nurses who are content to be nurses that gets under my skin. It's all ego.

 

[fab4fan]

This isn't infighting in the nursing profession.

This is a self-righteous NP patronizing real RNs.

Something tells me FamerJane and telenurse didn't need anyone to tell them what they "really" do or how important they are.

Bingo.

 

[horsenurse25]

Since when is a debate infighting?

Why cannot people have a disagreement without it being termed 'fighting'?

If I disagree with a statment or philosophy I am knocking someone down?

If I disagree with a nurse or a physician I am insulting them and their professions?

Huh?

At any rate, never in my post or anywhere else am I belittling fellow nurses. Nowhere. Perhaps it is diffucult to have a discussion on a public board where disparaging comments and ridicule is the norm.

Minimum wage in utah is $6.55, soon to be $7.55. Nurses start at $16. Not much higher than minimum in my opinion. Especially when you consider that in other States nurses start at $40. My comment about the wage was amalgomated from another post on this board where wage was mentioned. A post that Jane herself participated in. And how much more do doctors make in that state? Is that a fair balance??? That the 'eyes and ears' as everyone so insists on repeating should make a mere pittance??

And Fab4 - actually, yes. I am a member. I DO go to conventions. I actually just came back from one in Manitoba - admittedly it was for the Canadian Nurses, but my husband has family there so I thought I would combine both things. It was -40 degrees. Now I know why they have tunnels there. Very fun, exciting meeting with lots of fantastic speakers (and I came back with 20 pounds worth of freebies). I also do not agree with everything Unions say either. But they have done a lot of good fur us too.

And finally, my post was not to belittle nurses. Quite the contrary. Perhaps I am not a very eloquent writer. Perhaps people are not thorough readers. Or perhaps people are so ready to be defensive they do not understand support, no matter how badly written.

 

[horsenurse25]

This isn't infighting in the nursing profession.

This is a self-righteous NP patronizing real RNs.

Something tells me FamerJane and telenurse didn't need anyone to tell them what they "really" do or how important they are.

No it is a self-righteous real RN (who is also an NP) trying to get fellow nurses to speak about their profession as more than traditional handmaidens to physicians. Of course they know the truth, but for some reason most nurses have a really hard time telling the world about it.

Look at this board, look how many wanna be doctors think that nurses only exist to serve them?? It is not a malicious trend, but one born of ignorance. It is indicative of the public sentiment and official medical policy. It can only be changed if nurses speak up.

You can disagree with what I say all you like. But do not turn my words into 'infighting' or 'knocking down other nurses'.

 

[fab4fan]

I think I have made it abundantly clear on more than one occasion that I do not consider myself a doctor's "handmaiden." I also don't see the need to go whacking people over the head with how wonderful I think I am or how autonomous I think I am. I just do what needs to be done. And trust me, it gets noticed. You have to know your audience.

I don't know what part of the CNA you belong to, but I don't see them spending so much time blathering about autonomy. They seem to be focused on more important issues like safe ratios, universal health care, adequate compensation. This whole thing with the definition of autonomy sounds more like the stuff the ANA puts out.

In any case, if it makes you feel better to demand that nurses identify themselves as autonomous professionals, fine. In the meantime, I'll be doing my job, taking care of patients, not really giving a rip whether or not I'm defined that way. I'm more concerned that there will be enough nurses to take care of the patients, not how autonomous people think we are.

 

[Moniker]

No it is a self-righteous real RN (who is also an NP) trying to get fellow nurses to speak about their profession as more than traditional handmaidens to physicians. Of course they know the truth, but for some reason most nurses have a really hard time telling the world about it.

Look at this board, look how many wanna be doctors think that nurses only exist to serve them?? It is not a malicious trend, but one born of ignorance. It is indicative of the public sentiment and official medical policy. It can only be changed if nurses speak up.

You can disagree with what I say all you like. But do not turn my words into 'infighting' or 'knocking down other nurses'.

wow you're determined to pretend your posts are "enlightening" the "poor RNs". This is really a pretty simple issue and I don't want to confuse that by responding to your ridiculous acrimony-mongering. no one's saying any of the things you claim they are, but if you want to be the victim, I think you will be anyway.

on the plus side, all this horsenurse on this thread has provoked some pretty respectable posts from the other RNs.

 

[Taurus]

Minimum wage in utah is $6.55, soon to be $7.55. Nurses start at $16. Not much higher than minimum in my opinion. Especially when you consider that in other States nurses start at $40.

Have you ever heard of a concept called cost of living? In Utah, the pay is lower, but so is the cost to live there. If you were in San Francisco, the pay is closer to $50/hour because it costs more to live there.

For the amount of training they get, staff nurses are paid very well. Even as you stated below, a nurse with an RN or BSN with some years of experience under their belt can pull in $70-80k or more per year. Relative to other fields, that's pretty damn good. I know many engineers, accountants, and lawyers who don't do as well as nurses. You need to step back and get some perspective.

But Washington is great. My sister-in-law just moved there and got hired (head hunted actually) on as a staff nurse in Washington state. She has 8 years experience in med/surg. She is making $87,000 per year. She said that she thought about Oregon, but the average wage there is only about $70,000 - $75,000 at her level.

What I think what the issue for you is that you want the same authority and income as physicians without having even close to same level of training. In essence, you want a shortcut. You have this grandiose sense of entitlement. Is it because you couldn't cut it in medical school and that bitterness is manifesting itself as a desire to be viewed as equivalent to a doctor?

For me, I have no problems with nurses trying to play doctor. I say let them. I have seen enough of medicine to know that there is a reason why it's unwise to let someone with just 2 years of training and just 1000 clinical hours to work independently, especially in an inpatient setting. There will be enough hot shot young nurses who think that they can play doctor. They will make many mistakes and many patients will suffer and die because of it. Then the federal govt will step in and reign in on the hodgepodge of state laws governing "advanced nursing" practices.

Was I the only one here who read about Congress planning to crack down on the emergency rooms of physician-owned hospitals? You see, these hospitals didn't have doctors staffing their emergency rooms and instead relied on non-physicians like RN's, NP's, or PA's. When the patient had a medical emergency, they didn't know what to do so they called 911! [how funny is that?] These poor patients had to be transferred to a hospital that did have doctors available. Two patients needlessly died because of the poor care. Now Congress has these hospitals in their crosshairs. So be careful of what you wish for.

Limits Weighed on Physician-Owned Hospitals

Physician-Owned Hospitals Faulted on Emergency Care

 

[deleted6669]

T- neither of your articles is talking about e.d.'s staffed by midlevels. they are talking about places that are essentially surgical ctrs having only an rn( not even an np) in house. big difference.
for what it's worth when a pa covers an emergency dept solo they always have a physician back up available on call so if ems calls and says" we have a multicasualty incident with 3 critical pts, eta 10 min" the pa can call in a doc to double cover the dept. additionally the doc can be called in by the pa for cases that exceeed the pa's skills/knowledge or to do a diagnostic or therapeutic procedure that the pa is not credentialed to do.
something like 18-20 states allow a pa to staff an ed with physician back up available by phone. good care is delivered in these facilities and has been for > 35 yrs at this point.
these facilities for the most part are in health provider shortage areas and are designated rural critical access hospitals so they need federal assistance even to pay the salary of the pa as they typically see less than 1000 pts/mo through their emergency depts.
I work at 2 such facilities. I make less there than at my regular job but it is a fair trade off due to the increased autonomy/scope of practice and the variety of pts I see and procedures I perform. for what it is worth I do get phone consults as needed but have yet to EVER call in the on-call doc to help out.
no arguement from me that a residency trained/boarded em doc is the gold standard in em.
these places can't afford the 200k+ salary for an em doc though so they pay me less to perform most of the same duties.

 

[zenman]

They will make many mistakes and many patients will suffer and die because of it.

Just to be fair, doesn't this also apply to doctors?

And fab could you please change your avatar before I throw up. Maybe Willie Nelson...

 

[fab4fan]

Just to be fair, doesn't this also apply to doctors?

And fab could you please change your avatar before I throw up. Maybe Willie Nelson...

Not a chance. In fact, now that I know Bob Dylan annoys you, I may have to have a new Bob Dylan avatar every month, just to bug you. Because that's the sweet and charming sort of gal I am.

 

[PhysioMan]

Not a chance. In fact, now that I know Bob Dylan annoys you, I may have to have a new Bob Dylan avatar every month, just to bug you. Because that's the sweet and charming sort of gal I am.

You're the "warm and fuzzy" type of nurse, aren't you...😉

 

[telenurse]

This isn't infighting in the nursing profession.

This is a self-righteous NP patronizing real RNs.

Something tells me FamerJane and telenurse didn't need anyone to tell them what they "really" do or how important they are.

I think she forgets what the definition of a nurse is.

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.
— International Council of Nurses

The use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death."​

—Royal College of Nursing UK [6]​

Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations.​

—American Nurses Association​

Now...who wants to go into a refresher into nursing theory on how we put this into nursing practice.

I think Horsenurse wants to blur the lines between practicing nursing and practicing medicine. Also, your not going to make any friends by putting down those nurses "in the trenches" who actually enjoy and love hospital nursing. Remember, even Florence started out at the bedside.

Also...
you say you don't disparage nurses...but you say ICU nurses are "GOD/DESSES"???
So what does that make acute care, long term care, school, hospice, dialysis, industrial, flight, ED, and all the other myriad fields of nurses??? ICU nurses are nurses with a specialty just like any other nurse. Trust me, working step down cardiac I've found many cases of neglect, skin breakdown, med errors, missed labs, incorrect charting, you name it from your false gods in the ICU. Good and bad nurses exist everywhere. Just because your pt is on a vent and pressors doesn't mean that you are a better nurse than the person utilizing validation therapy while taking care of Grandma with dementia down at Southern Oaks rest home.

Are you intimidated by nurses that don't seek high technology or higher degrees in their practice...or is that just the impression you give me. I believe in Evidence based practice, but evidence based practice doesn't require me to know how to care for a vent or to have a fancy degree, RN is good enough for me.

 

[fab4fan]

You're the "warm and fuzzy" type of nurse, aren't you...😉

What was your first clue? 😉

 

[Taurus]

Just to be fair, doesn't this also apply to doctors?

This is why it's practically impossible for someone to get credentialed and malpractice these days without residency. The residency-trained physician is the gold standard. Period. If any physician fails to deliver standard of care, then they're in trouble as well.

Let's take a hypothetical. If you allow NP's now with minimal experience to get attending positions especially inpatient in some small hospital, what do you suppose the chance of something bad happening? It's pretty high. Midlevels can proclaim to do fine in the outpatient setting because those patients are stable. They can get away with mistakes and the patient probably won't die. It's different inpatient where the patients can be quite unstable. Once the mistakes start to rack up and the care by the NP's are shown to be lacking compared to the gold standard of a residency-trained physician, Congress will conduct hearings and there will be lots of hand-wringing. The final outcome will be some federal law that covers all midlevels under one umbrella. It'll be like the Flexner report II. I think it's just a matter of time before something like this will happen. A hodgepodge of state laws makes no sense.

As far as I know, there's no law preventing some NP with zero clinical experience outside of classroom to work independently. Now that's extremely scary. The unwary public needs to be protected from this. Only good judgment makes most people realize that they need to get some experience before going independent. However, there are no doubt quite a few of what I would call "cowboy" NP's who have no realworld experience but who think they are just as good as physicians and immediately go independent. These are the people that the NP's should worry about. They are ones who will hurt the profession.

 

[Taurus]

T- neither of your articles is talking about e.d.'s staffed by midlevels. they are talking about places that are essentially surgical ctrs having only an rn( not even an np) in house. big difference.

They just mentioned non-physicians so I wasn't sure what they groups they were specifically referring to.

Either way, I would be really uncomfortable if Congress has its sights on my specialty. I wouldn't be surprised if the final bill that comes out mandates some kind of physician involvement for all emergency rooms. The question is just how far they will go. You can't predict how lobbyists for all of the special interest groups will influence the bill.

 

[deleted6669]

As far as I know, NPs don't manage inpatients independently anywhere, for exactly the same reason.

np's do exactly this in 11 states:
http://www.futurehealth.ucsf.edu/pdf_files/Chart of NP Scopes Fall 2007.pdf

cross reference the 11 in which they can work independently and rx independently.
I work with np's who do independent inpt work in 1 of those 11 states.

 

[Taurus]

It's all fun and games until someone loses an eye. In this case, the NP's, naturally, will explore and expand into every nook and cranny they can until some law stops them. The question is how far the public and politicians will let them. This is an important reason why NP's work so hard to blur the distinction between medicine and nursing by calling themselves "practitioners" or "providers". They don't want to remind the public of their backgrounds. Why they want the DNP so that they can justify introducing themselves as "Dr" to patients. Of course, when their backs are against the walls, they will happily proclaim that they are practicing "advanced nursing" and not medicine because they don't want to fall under the boards of medicine. It's all a powergrab game to them.

So let them try to play doctor. I'll eagerly wait to read an article about how people needlessly became injured or died because of their inferior care in the Washington Post and how Congress will open up an investigation. When it comes to patient safety, no politician wants to fall on the wrong side. They want their constituents to think that they're putting up the strongest safeguards possible

 

[core0]

np's do exactly this in 11 states:
http://www.futurehealth.ucsf.edu/pdf_files/Chart of NP Scopes Fall 2007.pdf

cross reference the 11 in which they can work independently and rx independently.
I work with np's who do independent inpt work in 1 of those 11 states.

Thats not exactly true. Medicare requires physician supervision in all cases for inpatient billing. While technically an NP could practice independently in some states, I am not aware of any hospitals that allow independent inpatient practice as part of their medical staff bylaw. Not to say there isn't some really small nursing home pretending to be a hospital out there.

David Carpenter, PA-C

 

[Taurus]

Medicare requires physician supervision in all cases for inpatient billing. While technically an NP could practice independently in some states, I am not aware of any hospitals that allow independent inpatient practice as part of their medical staff bylaw. Not to say there isn't some really small nursing home pretending to be a hospital out there.

Isn't it bad public health policy to be regulating a group of healthcare providers through just Medicare reimbursement? You create a ton of loopholes then. Any NP can circumvent those regulations by simply opening up a clinic and accepting only cash. Those clinics in supermarkets that are springing up staffed by NP's or PA's take insurance or cash. I'm sure many cosmetic boutiques staffed by NP's are cash-based. Did you hear that there is an investigation into botox because something like 60 deaths have been attributed to it? Something that seems innocuous can have deadly consequences.

The solution is a strong patient safety first federal law that mandates the limits of midlevels. It would wipe away this hodgepodge of state laws, which NP's have successfully weakened through their lobbying, and eliminates as many loopholes as possible.

 

[deleted6669]

at my facility the np's do not admit their own pts but manage pts admited to their services without physician involvement.
for example on the psych service-
pt admitted to dr smith, staff psychiatrist who deals only with psych issues. all MEDICAL issues are dealt with by the np. so the doc deals with the schizophrenia, adjusts psych meds and does therapy but the np manages the pts dm, htn, thyroid issues, dehydration, renal probs, etc and takes call for everything except psych related issues with regards to that pt.
I imagine for billing purposes they bill for both the np and the doc although the doc is not supervising the np anymore than a hospitalist is being supervised by a surgeon when they comanage a patient.
there are lots of outpt np's running their own clinics in these 11 states. to their credit these are mostly in health provider shortage areas.
for example:
http://www.theskanner.com/index.php?action=artd&artid=3807
http://www.careoregon.org/carenews/2006/summer/nurse-practirioner-clinic-move.html
http://www.bridgecitymedical.com/about-us.html

and lest we forget....
http://www.capna.com/

 

[zenman]

Not a chance. In fact, now that I know Bob Dylan annoys you, I may have to have a new Bob Dylan avatar every month, just to bug you. Because that's the sweet and charming sort of gal I am.

My kitty is going to eat Bob...🙂

 

[OnPump]

They can get away with mistakes and the patient probably won't die. It's different inpatient where the patients can be quite unstable.

You could also argue that there is more potential for patients to fall through the cracks in the outpatient setting. If the "gatekeeper" isn't mindful, warning signs go unnoticed, for longer....

The acuity is different between in and outpatient, but the need for attention to detail is still warranted. There are many practices throughout the US where patients are managed exclusively by NPPs, given that only a percentage of the NPPs panel will be subject to chart review.

I understand your thinking about the level illness in the inpatient setting, but without evidence that NPs are inferior I don't know if you can make that statement (other than it being just opinion, which you have a right to)....

 

[Moniker]

You would assume that NPs provide inpatient care equivalent to MDs until proven otherwise?

well we have to. otherwise we might risk hurting some feelings.

 

[silas2642]

I have a thought a little about your posts on this thread Jane. And honestly, I disagree with the basic tone of them.

I have worked med/surg for many years then I went on to become an NP in geriatrics (although I am often in the hospital since so many of our residents end up in medical of course). I really love being a nurse. I do not see my job as being the 'eyes and ears' for the physician. I do indeed think that implies a subordinate role. And this is the issue with nurses world wide.

In California nurses have a very strong voice, and have worked hard for autonomy in their setting. Of course we have a scope of practice. Naturally there are things we cannot do without a physician's order.

HOWEVER, in the eyes of the public the stereotypical subservient handmaiden's role is what they think of when they see a nurse. THAT is why a person of your talents, experience and education gets little more than a teenager at McDonald's.

Here are the conditions for nurses in California http://www.calnurses.org/membership/model-contracts/

As you say, you admit patients and the doctor gives orders based on your assessment. That is huge, and it happens all the time. Why on earth are you getting paid a fraction of their wage then? How many patients have you saved because you are front line and alerted the physician about the condition, who then acted upon it? If you did not have a very good idea of what was happening and what needed to be done, you would not have known to make the call. In many cases the phone call is a formality. And you know as well as I that if I did not have a good idea of what to do and suggestions to make to the doc when I call, I would be delinquent in my duty (and the doc would wonder if I really knew what I was doing or not).

We do not merely 'report' we also advise. We advocate. We tell the physicians what we think, and they are happy to hear it. We act on behalf of the patient, we double check the physician's work. And that is something that most people do not know that nurses do.


Unless nurses start standing up and making the public know what they do, they will continue to work for peanuts.
Doctors, REAL doctors, already know. But the ignorance on this board alone is representative of the public ignorance and that must change.🙂

Wow. Again, I'm speechless-- it doesn't happen to me all that often, but horsenurse's posts seem to have that affect on the medical community as a whole because they are just so... out there.

So about the nurse being the "subordinate" to the physician. Yeah, I know that in today's politically correct world, it's really not nice to say that anyone is a subordinate to anyone and that the janitor and candy striper should have just as much say in the patient's care as the attending physician, but let's face it, a patient's life/well being is potentially at stake here and when the crap hits the fan it's going to hit his/her face first, so logically (at medical school they teach us to use logic) the person with the most training and education is usually put at the head of the team. That mean he/she is in charge. This does not mean this is the only person who matters in the team, that there are not other key members of the team (i.e. residents, nurses, NP's, PA's, CNA's, etc.), but there is a pecking order and the attending physician has the final authority-- his/her opinion in most cases matters the most because he/she is the most qualified to make the decisions.

I love it when RN's/NP's get all pissed off when techs don't follow their orders or treat them with disrespect-- they're all like, "that tech think she knows everything, but she didn't go to nursing school!" Well, doctors feel the same way. I don't think you guys have a clue what you don't know and you can't until you go to med school and go through residency. You may think a patient has a certain problem, and it's really critical to alert the physician to this, but at the same time, you have to understand that the physician may see things that you don't due to a greater fund of knowledge and breadth of experience.

As for nurses having autonomy, give me a break. You're nurses, it's a virtuous job that is highly valued by all of society. You are warm, tender, caring, smart, and you pick up on things that physicians would otherwise miss because they just don't have the time to be with their patients like you do. However, it was not a position that was ever made to be autonomous. You just don't go to school for four years, come out with a bachelors and start practicing any form of medicine. For that matter, I don't think you do 2 years of a post bac and start practicing medicine by yourself, either. In my hometown I'm really getting irritated to see nurses threatening to go on strike every other month when they're making great pay after only four years of college, working 36 hours a week, and getting scheduled breaks. Give me a break.

Oh yeah, and don't you think you're just being a little bit dramatic about the pay? You guys are making more than the residents, so quit whining. Nurses make great money-- you put in four years of college and you make great bank plus benefits. If you put in overtime, that's time and a half which is even better cash. Cry me a river.

I don't see why nurses aren't proud to be nurses anymore. What is this push to change nursing into something entirely different? It's kind of annoying. I mean, really, if you want to make assessments on patients, do treatment planning, prescribe medications, etc, go to med school like the rest of us and stop trying to change the rules.

 

[silas2642]

You could also argue that there is more potential for patients to fall through the cracks in the outpatient setting. If the "gatekeeper" isn't mindful, warning signs go unnoticed, for longer....

The acuity is different between in and outpatient, but the need for attention to detail is still warranted. There are many practices throughout the US where patients are managed exclusively by NPPs, given that only a percentage of the NPPs panel will be subject to chart review.

I understand your thinking about the level illness in the inpatient setting, but without evidence that NPs are inferior I don't know if you can make that statement (other than it being just opinion, which you have a right to)....[/QUOTE]

Well, I guess it shouldn't be said that NP's provide inferior care since there isn't any really direct evidence to state that. On the other hand, there isn't really any evidence in the literature indicating that healthcare workers recruited directly off the streets wearing giant chicken costumes with no prior medical experience and only a GED will provide inferior patient care vs. an attending physician. However, reason would dictate that the attending physician, having had the advantages of both a far more extensive and rigorous medical background, would be able to outperform the chicken man. Of course, some people are always going to say the chicken man is better, that less education is better, and that you really don't need to know any medicine to practice medicine. To each his own. But I say: beware of the feathers.

 

[OnPump]

You would assume that NPs provide inpatient care equivalent to MDs until proven otherwise?

I assume nothing, as I'm sure you shouldn't either as professional. That's the point of my comment.

 

[OnPump]

Well, I guess it shouldn't be said that NP's provide inferior care since there isn't any really direct evidence to state that. On the other hand, there isn't really any evidence in the literature indicating that healthcare workers recruited directly off the streets wearing giant chicken costumes with no prior medical experience and only a GED will provide inferior patient care vs. an attending physician. However, reason would dictate that the attending physician, having had the advantages of both a far more extensive and rigorous medical background, would be able to outperform the chicken man. Of course, some people are always going to say the chicken man is better, that less education is better, and that you really don't need to know any medicine to practice medicine. To each his own. But I say: beware of the feathers.

Hospitals generally don't hire people dressed in chicken suits for clinical roles, as it tends to severely slow the credentialling process.

For future reference, try to base your analogies somewhere in the vicinity of reality. You'll sound smarter.

Of course, some people are always going to say the chicken man is better, that less education is better, and that you really don't need to know any medicine to practice medicine. To each his own. But I say: beware of the feathers.

Look up "Straw Man".....

 

[Miss Mab]

How about for fun we stop with " the nurses" and whining about "the NP's" and "nursing". I'm sure it's fairly obvious, and something that isn't neccesarily always a good thing, but it is unquestionably obvious that there is NO cohesiveness in the nursing profession no mattter which level of educational preparedness you are referring to.

I'm not talking about being politically correct, I'm just saying some of you sound so stupid and out of touch with the realities in healthcare when you make these generalized statements about what "the nurses" think, want or desire to have for the profession.

There is a very vocal "ivory tower" contingent that has lots of lofty goals for complete autonomy and independence and doctoral preparation for example that I'd dare to say the vast majority of nurses have no interest in. We may agree with some or none of the proposals but you really gotta understand that it's not only not everyone, it's also not many. Which is why you'll often find the ones spouting off on many of the divisive subjects being other competing professions---after all, what better way to deflect attention to their own house, eh? Despite whatever makes you feel better, many who choose the midlevel role, PA, NP or otherwise, certainly could have set out on the pre-med route and probably a few wish they had back in the day. Not all, absolutely, but it is so disingenuous when I read over and over how "nurses" would never make it in med school and shouldn't desire an expanded role becuase they didn't make that choice. It's a false argument. And of course, the buck stops with you guys. Wait, sorry, the buck stops with the residency trained physicians 🙂 Who has a problem with that? Just saying "we" do doesn't make it so.

Oh, dare to dream...

Anyway, I also happen to live where we are threatening to strike and actually have twice now. Please tell me you don't think it's about money, etc. We darn well know we are paid well. I only graduated two years ago and certainly made more than six figures just my first year out. It's a shame other parts of the country don't value their nurses as well because you can' tell me that the cost of living here is a reason why PA nurses start at $16/hr. and I started at $48. It's not that big a difference....

I went on strike, and will again, because I am sick of working understaffed and without basic equipment necessary to take care of our patients. I work in the ER for a multi million dollar profit making co. On any given night, I cannot find a pump for god's sake when I need to hang oh say, unimportant critical meds like dopamine, levo,nitro, etc. I'm saying, literally, there are none. Anywhere. There is also ONE portable pulse ox for a 36 bed ER. It's a little hard to do continuous monitoring on our AMI work-up hallway patients with that. But who cares anyway...right? I also worry about understaffing when I have vented patients, multiple drips and a new STEMI rolling in and no extra hands to pitch in. I'm fairly certain that I'm gonna miss your 30 minute door time even if i utilize the fancy jazz hands. I don't need to 'work smarter'--it's a physical impossibility unless we genetically engineer extra arms and legs. I also hate working somwhere where IC cleans the area maybe once a day if we are lucky. The public is worried about handwashing? Just don't touch any surface anywhere is more like it...Oh yeah, and that one negative pump for our TB workups? yeah, that broke 4 months ago. Oh well.

Anyway, it's not about money. Please believe it's about being given the tools to keep all of our patients alive safely.

 

[Taurus]

I understand your thinking about the level illness in the inpatient setting, but without evidence that NPs are inferior I don't know if you can make that statement (other than it being just opinion, which you have a right to)....

This is why I favor allowing NP's, especially the ones who have zero realworld clinical experience, to work as attendings in tertiary level hospitals right now. In fact, let's fire all of the physicians and replace them with just NP's. I agree that we need cold hard data to back up our assumptions.

 

[fab4fan]

You may think a patient has a certain problem, and it's really critical to alert the physician to this, but at the same time, you have to understand that the physician may see things that you don't due to a greater fund of knowledge and breadth of experience.

As for nurses having autonomy, give me a break. You're nurses, it's a virtuous job that is highly valued by all of society. You are warm, tender, caring, smart, and you pick up on things that physicians would otherwise miss because they just don't have the time to be with their patients like you do. However, it was not a position that was ever made to be autonomous. You just don't go to school for four years, come out with a bachelors and start practicing any form of medicine. For that matter, I don't think you do 2 years of a post bac and start practicing medicine by yourself, either. In my hometown I'm really getting irritated to see nurses threatening to go on strike every other month when they're making great pay after only four years of college, working 36 hours a week, and getting scheduled breaks. Give me a break.

Oh yeah, and don't you think you're just being a little bit dramatic about the pay? You guys are making more than the residents, so quit whining. Nurses make great money-- you put in four years of college and you make great bank plus benefits. If you put in overtime, that's time and a half which is even better cash. Cry me a river.

I don't see why nurses aren't proud to be nurses anymore. What is this push to change nursing into something entirely different? It's kind of annoying. I mean, really, if you want to make assessments on patients, do treatment planning, prescribe medications, etc, go to med school like the rest of us and stop trying to change the rules.

Believe it or not, it is within my scope of practice to assess patients and to report what I find to a physician. It's up to the physician to decide what to do from there. On really rare occasions (I can think of two in 23y) I have had to go up the chain of command because what the attending chose to do was clearly not appropriate. That's my job, too.

Please drop the references to nursing being some sort of ethereal, warm, fuzzy, hand-holding occupation. Yes, I do hold patients' hands when the occasion calls for it, but that's not all I do. God, I hate it when people describe nursing in those terms. It's such a small part of what we do, and it diminishes us.

You're sick of seeing nurses strike? Do you even know what nurses really go on strike over? Do you know what has to happen to get to the point that nurses go on strike? Do you know how much money hospitals are willing to pay strike-breaking nurses? You think nurses striking for safe-patient ratios are selfish? Please educate yourself about all of the issues related to nurses striking before you have another temper tantrum.

Horsenurse didn't do many of the nurses here any favors, but you're not exactly a great representative of your profession either.

ETA: I should have known that came from a med student.

 

[OnPump]

This is why I favor allowing NP's, especially the ones who have zero realworld clinical experience, to work as attendings in tertiary level hospitals right now. In fact, let's fire all of the physicians and replace them with just NP's. I agree that we need cold hard data to back up our assumptions.

Again, see "Straw Man".....

You guys take hyperbole to an art form.

 

[fab4fan]

Anyway, I also happen to live where we are threatening to strike and actually have twice now. Please tell me you don't think it's about money, etc. We darn well know we are paid well. I only graduated two years ago and certainly made more than six figures just my first year out. It's a shame other parts of the country don't value their nurses as well because you can' tell me that the cost of living here is a reason why PA nurses start at $16/hr. and I started at $48. It's not that big a difference....

I went on strike, and will again, because I am sick of working understaffed and without basic equipment necessary to take care of our patients. I work in the ER for a multi million dollar profit making co. On any given night, I cannot find a pump for god's sake when I need to hang oh say, unimportant critical meds like dopamine, levo,nitro, etc. I'm saying, literally, there are none. Anywhere. There is also ONE portable pulse ox for a 36 bed ER. It's a little hard to do continuous monitoring on our AMI work-up hallway patients with that. But who cares anyway...right? I also worry about understaffing when I have vented patients, multiple drips and a new STEMI rolling in and no extra hands to pitch in. I'm fairly certain that I'm gonna miss your 30 minute door time even if i utilize the fancy jazz hands. I don't need to 'work smarter'--it's a physical impossibility unless we genetically engineer extra arms and legs. I also hate working somwhere where IC cleans the area maybe once a day if we are lucky. The public is worried about handwashing? Just don't touch any surface anywhere is more like it...Oh yeah, and that one negative pump for our TB workups? yeah, that broke 4 months ago. Oh well.

Anyway, it's not about money. Please believe it's about being given the tools to keep all of our patients alive safely.

Thanks for pointing out that there are significant disparities in compensation depending on what part of the country you work in and that strikes are often about more than just money. Sometimes they're not even about money at all.

 

[Taurus]

Again, see "Straw Man".....

You guys take hyperbole to an art form.

It's a sign of confidence. I'm confident that NP's will not be able to perform anywhere close to a physician in an inpatient setting, especially not at a tertiary center. I'm confident that if we did allow NP to do so that many people will needlessly suffer and die. If you don't think so, I doubt that you have much experience in an inpatient setting.

 

[OnPump]

If you don't think so, I doubt that you have much experience in an inpatient setting.

10+ yrs.
And that's where your assumptions kill you.....your doubts are unfounded.
Where does your "confidence" come from that NPs will cause patients to suffer and die? What is your experience? (outside of med school that is 🙄)...enlighten me, it's what I live for....

Add melodrama to hyperbole. Laughable.......

 

[f_w]

It's a sign of confidence. I'm confident that NP's will not be able to perform anywhere close to a physician in an inpatient setting, especially not at a tertiary center. I'm confident that if we did allow NP to do so that many people will needlessly suffer and die. If you don't think so, I doubt that you have much experience in an inpatient setting.

Uninformed comments of this nature weaken your case.

 

[silas2642]

How about for fun we stop with " the nurses" and whining about "the NP's" and "nursing". I'm sure it's fairly obvious, and something that isn't neccesarily always a good thing, but it is unquestionably obvious that there is NO cohesiveness in the nursing profession no mattter which level of educational preparedness you are referring to.

I'm not talking about being politically correct, I'm just saying some of you sound so stupid and out of touch with the realities in healthcare when you make these generalized statements about what "the nurses" think, want or desire to have for the profession.

There is a very vocal "ivory tower" contingent that has lots of lofty goals for complete autonomy and independence and doctoral preparation for example that I'd dare to say the vast majority of nurses have no interest in. We may agree with some or none of the proposals but you really gotta understand that it's not only not everyone, it's also not many. Which is why you'll often find the ones spouting off on many of the divisive subjects being other competing professions---after all, what better way to deflect attention to their own house, eh? Despite whatever makes you feel better, many who choose the midlevel role, PA, NP or otherwise, certainly could have set out on the pre-med route and probably a few wish they had back in the day. Not all, absolutely, but it is so disingenuous when I read over and over how "nurses" would never make it in med school and shouldn't desire an expanded role becuase they didn't make that choice. It's a false argument. And of course, the buck stops with you guys. Wait, sorry, the buck stops with the residency trained physicians 🙂 Who has a problem with that? Just saying "we" do doesn't make it so.

Oh, dare to dream...

Anyway, I also happen to live where we are threatening to strike and actually have twice now. Please tell me you don't think it's about money, etc. We darn well know we are paid well. I only graduated two years ago and certainly made more than six figures just my first year out. It's a shame other parts of the country don't value their nurses as well because you can' tell me that the cost of living here is a reason why PA nurses start at $16/hr. and I started at $48. It's not that big a difference....

I went on strike, and will again, because I am sick of working understaffed and without basic equipment necessary to take care of our patients. I work in the ER for a multi million dollar profit making co. On any given night, I cannot find a pump for god's sake when I need to hang oh say, unimportant critical meds like dopamine, levo,nitro, etc. I'm saying, literally, there are none. Anywhere. There is also ONE portable pulse ox for a 36 bed ER. It's a little hard to do continuous monitoring on our AMI work-up hallway patients with that. But who cares anyway...right? I also worry about understaffing when I have vented patients, multiple drips and a new STEMI rolling in and no extra hands to pitch in. I'm fairly certain that I'm gonna miss your 30 minute door time even if i utilize the fancy jazz hands. I don't need to 'work smarter'--it's a physical impossibility unless we genetically engineer extra arms and legs. I also hate working somwhere where IC cleans the area maybe once a day if we are lucky. The public is worried about handwashing? Just don't touch any surface anywhere is more like it...Oh yeah, and that one negative pump for our TB workups? yeah, that broke 4 months ago. Oh well.

Anyway, it's not about money. Please believe it's about being given the tools to keep all of our patients alive safely.

You are making 6 figures 2 years out of nursing school? You started at $48/hour after a bachelors-- I know I'm just the dumb med student here, but maybe the reason your department can't afford any equipment is because of the enormous amount of money they're paying all the nurses. You are making more than twice the salary of a resident which is ridiculous. (I know that I'm going to get flamed for this one). Seriously, though-- if that's the amount of money it takes to staff 1 RN, that has to cut into the budget substantially.

And don't tell me that it's not about the money because it's always about the money. That was the first thing on the agenda during every strike in our local hospital-- lack of pay raises. Yeah, it may be about patient care too, and I'm definitely not saying that nurses don't care about patient health, a lot of them still do (just not the ones in administration, they just seem to push paper), but you can't tell me it's not about the money.

 

[fab4fan]

OK, we can't tell you it's not just about money. And certainly, we can't tell you about why nurses strike at other facilities, because you are going to be stiff-necked in your determination to relate everything to your own little world instead of thinking there might be a bigger picture out there.

Maybe you and Taurus should go into practice together when you finally get out of med school and finish your residencies. Your mutual "doom and gloom" POV would make you well suited for each other as partners.

 

[OnPump]

I know I'm just the dumb med student here, but maybe the reason your department can't afford any equipment is because of the enormous amount of money they're paying all the nurses. You are making more than twice the salary of a resident which is ridiculous.

Remember Bubba?

"It's the economy, stupid!"

Other factors like supply of RNs and local COL influence salaries, irrespective of resident salaries.

Comparing salaries of physicians in training to staff nurses isn't a sound argument, as the determinants of each are completely different....

I know, it's easier to complain about an RN making almost as much as a pediatrician....

 

[Miss Mab]

I already mentioned that I know I make good money. I happened to be from the area, wanted to make a career change after the first degree, looked around at the various areas of healthcare that I was suited and prepared for and chose nursing. Cost/benefit wise you're darn right the $$$ in CA was a factor. So much for those dumb nurses, eh?

I'm disheartened but not surprised that only another RN can understand the forces that motivate nurses to strike. I don't know about whatever area the other poster is from but I can guarantee you that pay raises were NOWHERE on our agenda when we chose to strike--and will again soon BTW. IT'S NOT SAFE! Please take a look around the next time you're doing rounds or dropping by or whatever.

Also, I sincerely doubt that my pay is what is keeping my unit understaffed and not well equipped. Hello? My NON PROFIT company made 650 million last year. I think they can afford to provide necessary staff/resources to actually, y'know, care for patients.

As an aside, it always cracks me up that when you ask for a med or a pump or O2 equip or whatever, that admin./pharamacy/supervisors or whoever acts like you are doing it for some sort of personal gain. As if I, Miss Mab RN, just want to be irritating and greedy by asking for these things. I could give a rip on a personal level. It's not about me/nurses. It's about the patients....
Sometimes it appears we're the only ones who care if they get what they need to keep, I don't know, breathing...........

 

[telenurse]

I don't see why nurses aren't proud to be nurses anymore. What is this push to change nursing into something entirely different? It's kind of annoying. I mean, really, if you want to make assessments on patients, do treatment planning, prescribe medications, etc, go to med school like the rest of us and stop trying to change the rules.

Actually assessing and making a care plan with is part of the nursing process...Silas...please reread the definition of nursing..

Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations.​

—American Nurses Association


​

 

[telenurse]

I used to work for a facility like Miss Mab describes...
It was against policy and a nurse could be reprimanded up to and including termination for hanging IV's without an IV pump, except for in a code situation, but there were never enough IV pumps...I remember using the same pump on 4 different pt's and just cleaning it with bleach between their intermittent antibiotics, and getting written up for that because it was against the rules also. But the pt's got their meds. Granted the meds were really late.

One manual blood pressure cuff for 40 patients and it didn't work...I kept my own in my locker. Because I never trust a machine with really low or high BP's

I was expected to be the ONLY RN for 25 pt's, 10 of which were recieving IV chemotherapy and blood. (Taxol, cisplatin, vincristine, FFP's, etc.) How safe is that? (Life became miserable after I file a complaint, stating that the situation was unsafe and put pt's lives in jeopardy. Think about it, if you were an oncologist, would you want your chemo nurse stretched that thin, especially with your patient getting taxol?)

I quit as soon as possible and never looked back.

 

[zenman]

It's a sign of confidence. I'm confident that NP's will not be able to perform anywhere close to a physician in an inpatient setting, especially not at a tertiary center. I'm confident that if we did allow NP to do so that many people will needlessly suffer and die. If you don't think so, I doubt that you have much experience in an inpatient setting.

Aren't there neonatal units that are packed full of neonatal nurse practitioners?

 

[Taurus]

Uninformed comments of this nature weaken your case.

I seriously don't think that they can. I believe enough in that that I think we should let them go ahead and become attendings and look at their outcomes in tertiary centers. For ethical and safety reasons, this will never happen except maybe at some tiny hospital in the boonies that can't find anyone to come out there except a midlevel.

 

[silas2642]

OK, we can't tell you it's not just about money. And certainly, we can't tell you about why nurses strike at other facilities, because you are going to be stiff-necked in your determination to relate everything to your own little world instead of thinking there might be a bigger picture out there.

Maybe you and Taurus should go into practice together when you finally get out of med school and finish your residencies. Your mutual "doom and gloom" POV would make you well suited for each other as partners.

Ow, that really hurt. No, there is no doom and gloom here. I just wish that things were the way they used to be-- when doctors used to be doctors and when nurses actually used to be nurses and liked their role without trying to want to expand it into something that it was never intended to be.

 

[silas2642]

Actually assessing and making a care plan with is part of the nursing process...Silas...please reread the definition of nursing..

Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations.​

—American Nurses Association


​

Wow, the definition of nursing that was set up by the American Nurses Association-- why do I think that this definition has changed in the past few decades, and how does this sound a lot like the definition of a physcian's role as well?

 

[Faebinder]

Because you misunderstand the distinction between the medical and nursing models of health care. It's not suprising, because while we may understand the technical nature of nursing, you will never be exposed to the theory behind it unless you seek it out yourself. Once you understand what is meant by words like diagnosis and treatment in the nursing model, this isn't nearly as sinister as you make it out to be.

Try more alien words like morbidity and risk.

 

[Farmer Jane]

Because you misunderstand the distinction between the medical and nursing models of health care. It's not suprising, because while we may understand the technical nature of nursing, you will never be exposed to the theory behind it unless you seek it out yourself. Once you understand what is meant by words like diagnosis and treatment in the nursing model, this isn't nearly as sinister as you make it out to be.

There you go, ruining your rep again. 😉

When I make a nursing diagnosis it is to complement the medical diagnosis, not override it.

I'm sure most of us have heard about stupid nursing diagnosis such as "energy field disturbance" and honestly I find it embarassing that my profession has allowed this to make its way into our list of official diagnosis, but usually the diagnosis I make are things such as Pain: Chronic or Pain: Acute, Impaired Gas Exchange r/t COPD, Risk for Impaired Skin Integrity. These diagnosis shape the way we manage our care. For example, if I have a patient with COPD I'll be elevating the head, assessing lung sounds, monitoring SaO2 and adjusting oxygen to keep sats within a reasonable range depending on the patient (as you know, CO2 retainers don't exactly do well with SaO2 at 99%). For a patient with risk for impaired skin integrity (in other words, they are at high risk for decubitus ulcers) we reposition the patient every two hours, regularly assess the skin, especially at the sacrum. We clean the skin thoroughly when the patient is incontinent and apply barrier cream. That's the jist of nursing diagnosis as it relates to nursing care.

As has been said before, it's only a tiny ivory-tower minority of nurses who are wanting to take over medicine. Most of us (despite infighting, which yes, exists) find value in nursing itself. Certainly a technician could do some of the physical and technical things we do, but it takes a good nurse to do it well. In fact, one huge frustration I have with the NP push is that back when I was taking my Foundations and Theory of Nursing course (in 1999) the emphasis was on taking pride and finding value in our profession as a distinct and separate profession from medicine. Now it seems that tide is turing and the message from academia is turned into how we're not good enough if we're not competing with physicians. What?!? I thought we were supposed to separate? I don't WANT to compete! I like being a nurse. I have never wanted to be a physician. Ever. I actually think the NP push and competition with physicians (replacing corroboration WITH) has the opposite effect and once again we're back to nurses being "lesser than". After all, if NP is the same as an FP MD, doesn't that imply that RN is less than MD? That if RNs only went back and got more education they would be doctors? That's essentially what this whole NP movement is saying, and I don't appreciate it. I, for one, am not an RN because I failed out of medical school. I am an RN because from the time I was 16 years old I wanted to be a nurse, so that is what I did and I am rather proud of my career and accomplishments.

Rant over.

 

[f_w]

It is not like inpatient care is the holy grail of medicine and that only the highest qualified are worthy of making the life and death decisions required there every day. No reason why NPs and PAs with adequate experience can't manage inpatients. Given some of the poor care I have seen from insecure FPs and internists, a hospitalist PA or NP service would sometimes be a blessing.

I worked on a service where we had an NP that took care of most of the inpatient care. The patients however wheren't admitted under his name and he worked under the general supervision of the various attendings. The day to day decisions where up to him, not because he pulled out some ANA position statement to assert his independence, but because he had gained their trust over the years of teamwork.

PS. my wife and newborn baby are in the hospital right now. Many thanks to the RNs who take care of them as well as the CNM who skillfully assisted the OB during the c-section.

 

[Farmer Jane]

Congratulations!