Minnesota RNs facing competition from less-qualified

[okayplayer]

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Take this for what it is worth to you...I am not a smart-ass, I am not trying to blow smoke. I've never claimed to know how to treat a patient with an INR of 13.2, that's the doctors job. It is my job to know that a pt with an INR of 13.2 should not be taking ASA, Plavix and Coumadin on a daily basis until the INR comes down to a therapeutic level. She was taking 8 mg QD.

I ask you....Should I have left this patients home knowing what her INR was and what she was taking and not say anything, continue to let her believe she should continue on all three? What kind of nurse would I be?

Enough already. Coumadin is the only medication that would effect the PT/INR. It does not matter if the pt is taking ASA or Plavix -- it will have no bearing on PT/INR. This is the point these guys were getting at.

If the pt is supratherapeutic on Coumadin, this can be corrected by stopping the medication and giving Vit K and/or FFP depending on clinical judgement and the situation at hand (ie. acutely bleeding, going to the OR, etc).

PT/INR is only useful for Coumadin dosing. You can determine if the pt is at an efficacious dose of ASA or Plavix by doing platelet mapping or bleeding time.

 

[2win]

Take this for what it is worth to you...I am not a smart-ass, I am not trying to blow smoke. I've never claimed to know how to treat a patient with an INR of 13.2, that's the doctors job. It is my job to know that a pt with an INR of 13.2 should not be taking ASA, Plavix and Coumadin on a daily basis until the INR comes down to a therapeutic level. She was taking 8 mg QD.

I ask you....Should I have left this patients home knowing what her INR was and what she was taking and not say anything, continue to let her believe she should continue on all three? What kind of nurse would I be?



Laugh all you want dhb! Nurses can save your ass. If you have so much disrespect for nurses you're gonna be hell to work with. I don't claim to know what you know, I claim to be a good nurse, that's what I learned and that's what I do.

Over and out....I can't argue with someone who wants to argue with a nurse on a doctors level. The original subject was nurses vs medical assistants. I still say nurses are worth they're weight in gold, especially when they save your ass. Doctors do make mistakes, I know that must be hard for you to believe but they do. I've been a nurse probably longer than you've been alive.

Hey girl - take it easy...You see on this forum that we are a kind of rough and friendly in the same time. We understand each others pain and frustration. As for me - I have great nurses in OR and pain clinic. Their weight is in gold but when I hired them I took a good look at the BMI. I appreciate when I make a mistake if somebody is telling me. Except my English .
And let me be the same in all my posts - what do you think of Obama and nurses supporting him? And fu&*&*ck AMA - I am proudly NOT a member.

 

[Taurus]

The original subject was nurses vs medical assistants. I still say nurses are worth they're weight in gold, especially when they save your ass. Doctors do make mistakes

Everyone makes mistakes. A good nurse or medical assistant may see something that you overlooked. I agree with that.

Just like how NP's like to point out that not every encounter requires a physician, not every clinical task requires an overpaid nurse either. Physicians need to understand the skills and limitations of every group so that they can optimize their practices. Instead of 10 nurses, maybe the workflow only really requires 3 nurses and 7 medical assistants. That could be a huge cost savings.

 

[Paseo Del Norte]

Everyone makes mistakes. A good nurse or medical assistant may see something that you overlooked. I agree with that.

Yes, and in fact, it should work both ways.


Just like how NP's like to point out that not every encounter requires a physician, not every clinical task requires an overpaid nurse either.

However, every encounter should have at least some form of physician collobration.

Physicians need to understand the skills and limitations of every group so that they can optimize their practices.

I agree.


Instead of 10 nurses, maybe the workflow only really requires 3 nurses and 7 medical assistants. That could be a huge cost savings.

Sure, depending on the environment. I am an equal opportunity kind of guy. For example, I worked with "full scope" paramedics in the ER some years back and for the most part, they were good guys. Therefore, I never had a problem with paramedics working in roles that could be traditionally though of as nursing dominated. I admit I am rather ignorant of the private practice environment as my experiences are not specific to this area.

While we can disagree with some of what Dutch says, I think Dutch has some level headed views. Especially, in the area of Doctor nurses gone wild. That alone earns points. 👍

 

[Eta Carinae]

Enough already. Coumadin is the only medication that would effect the PT/INR. It does not matter if the pt is taking ASA or Plavix -- it will have no bearing on PT/INR. This is the point these guys were getting at.

If the pt is supratherapeutic on Coumadin, this can be corrected by stopping the medication and giving Vit K and/or FFP depending on clinical judgement and the situation at hand (ie. acutely bleeding, going to the OR, etc).

PT/INR is only useful for Coumadin dosing. You can determine if the pt is at an efficacious dose of ASA or Plavix by doing platelet mapping or bleeding time.

Damn, you mean we actually had to spell it out again for her?

Harrison in turning over in his grave in Birmingham right now for the atrocious failure to understand basic medicine from a nurse!!!!!!!!

and a nurse who claims to understand the "theory" behind what we do for patients...

A nurse knows a patient shouldn't be taking asa, plavix and coumadin and a nurse knows why.

Originally Posted by DutchgirlRN
I say an RN with a college degree, who knows the theory behind what they are doing, not just simply the mechanics of giving an injection is worth their weight in gold.

 

[dhb]

It is my job to know that a pt with an INR of 13.2 should not be taking ASA, Plavix and Coumadin on a daily basis until the INR comes down to a therapeutic level.

What if the patient was stented less than a month ago?

What kind of nurse would I be?

A killer nurse

Nurses can save your ass. Doctors do make mistakes.

That what this thread is all about? 🙄

 

[DutchgirlRN]

Enough already. Coumadin is the only medication that would effect the PT/INR. It does not matter if the pt is taking ASA or Plavix -- it will have no bearing on PT/INR. This is the point these guys were getting at.

If the pt is supratherapeutic on Coumadin, this can be corrected by stopping the medication and giving Vit K and/or FFP depending on clinical judgement and the situation at hand (ie. acutely bleeding, going to the OR, etc).

PT/INR is only useful for Coumadin dosing. You can determine if the pt is at an efficacious dose of ASA or Plavix by doing platelet mapping or bleeding time.

Thank You okayplayer. I appreciate your kind and informative answer.

 

[Coastie]

Thank You okayplayer. I appreciate your kind and informative answer.

DutchgirlRN,

Here is the point this board would like to convey to you in a kind and informative manner:

Stick to observing the patient, reporting any concerns you have to me, carrying out my orders, working together with me as a team for the patient, and clocking in your 8-12 hour shifts.

Please stop giving any medical advice to the patient. Please drop the whole "patient advocate" bit too.

Thanks,
Coastie

 

[DutchgirlRN]

And let me be the same in all my posts - what do you think of Obama and nurses supporting him?

This nurse does not support Obama. I think the nurses who support him need a reality check.

Instead of 10 nurses, maybe the workflow only really requires 3 nurses and 7 medical assistants. That could be a huge cost savings.

I totally agree. The problem I have is that when I go to the doctor whether it be my PCP, Cardiologist, ENT, Gynecologist, none of them have a single licensed nurse in their office. Even that I can deal with. A good MA is very capable and the one's I've dealt with are very capable and professional.

My major issue is that the doctor calls them his "nurses" and they refer to themselves as "nurses". It would be like a NP calling themselves a physician when indeed they are not. It's wrong. It's unethical and it's illegal. I went to school for 4 years and earned the right to call myself a Registered Nurse and I am proud to be a nurse. Everyone has their niche.

How the heck did I get lost in this forum anyway? You must have a nursing section?

 

[DutchgirlRN]

I don't give medical advice, that's not my job, that's your job.

DutchgirlRN,

Stick to observing the patient, reporting any concerns you have to me, carrying out my orders, working together with me as a team for the patient, and clocking in your 8-12 hour shifts.

The MA told the patient earlier that same day to take her coumadin as usual, I said to her I don't think that's your call, you need to ask the doctor. The doctor said hold the coumadin and recheck the INR in two days. I used my brains and put 2+2 together and came up with this patient doesn't need to be taking coumadin so let me call the physician. Did I do something wrong? My point was that the MA made a mistake.

I work 3 - 12 hour shifts in IR and 24 hours a week in Home Health.

Please stop giving any medical advice to the patient. Please drop the whole "patient advocate" bit too.

Sorry, I won't apoligize for being a patient advocate.

Thanks,
Coastie

 

[Eta Carinae]

DutchgirlRN,

Here is the point this board would like to convey to you in a kind and informative manner:

Stick to observing the patient, reporting any concerns you have to me, carrying out my orders, working together with me as a team for the patient, and clocking in your 8-12 hour shifts.

Please stop giving any medical advice to the patient. Please drop the whole "patient advocate" bit too.

Thanks,
Coastie

👍

 

[periopdoc]

I can't argue with someone who wants to argue with a nurse on a doctors level.

I never asked to argue at the physician level. I asked you to explain, on a nursing level, why

A nurse knows a patient shouldn't be taking asa, plavix and coumadin and a nurse knows why.

You clearly are not going to admit that you are wrong, even though I gave you ample opportunity to do so. So it seems like you are blowing smoke when you say that you are one of the few who are willing to step up to the plate and admit when you are wrong. I am disappointed as I have spent some time reading some of your other posts and I thought that you might be one of the good ones.

The original subject was nurses vs medical assistants. I still say nurses are worth they're weight in gold, especially when they save your ass.

Before I left primary care, I found that, in the office setting, the two were essentially interchangeable and both were equally good at keeping track of the things that I would typically forget/ screw up. The big difference was that my MA did not think that she understood medications and she would come and ASK ME what my plan was before telling a patient what she should do. My nurses tended to formulate a plan, inform the patient, and then tell me about it later. Most were pretty good at coming up with the same plan that I would even if they couldn't explain why.

From my perspective, it was more important for me to understand my MA's and nurses (and what their tendencies and limitations were) than to get hung up on whether I had an MA or a nurse working with me. BTW the best nurse/ MA I ever worked with was a certificate nurse.

I ask you....Should I have left this patients home knowing what her INR was and what she was taking and not say anything, continue to let her believe she should continue on all three? What kind of nurse would I be?

It is my job to know that a pt with an INR of 13.2 should not be taking ASA, Plavix and Coumadin on a daily basis until the INR comes down to a therapeutic level. She was taking 8 mg QD.

As I have already said, I never mentioned a management strategy for this patient, or criticized yours. You are just too stubborn to realize/ admit it. I do not have enough information to formulate a plan fully, but making a few assumptions, here is what I would suggest you consider.

1. ASA and clopidogrel (Plavix) have no effect on INR and thus are not contraindicated in patients with supratherapeutic INR's or in patients who are simultaneously taking coumadin. Therefore, unless there is ongoing bleeding, the Plavix and ASA should be continued as prescribed.
   
2. I suspect this patient is in need of both antiplatelet therapy and anticoagulation. She likely has coronary stents necessitating the antiplatelet therapies of Plavix and aspirin in addition to a-fib or a prosthetic valve requiring anticoagulation (coumadin). All three should be continued.
   
3. Given the supratherapeutic INR, coumadin should be temporarily held and the patient referred to a physician to determine why her INR became so supratherapeutic and when to restart her coumadin and at what dose. The patient may require vitamin K therapy to reduce her INR or simply adjustment of her coumadin therapy. (a physician level argument)
   
4. If this patient came to me, I would refer her to one of my nurses who specialize in outpatient coumadin therapy. A nurse who manages coumadin regularly will be able to figure out the appropriate regimen more quickly than I will and I am not afraid to admit it. Obviously I would evaluate the patient and reverse the anticoagulation first if I thought it was necessary

The key is that you are dead wrong when you say that "a nurse knows a patient should not be taking asa, Plavix, and coumadin and a nurse knows why." There is no reason that a patient should not be taking all three. In fact we routinely have patients on all three because each has a different mechanism of action and that is complementary to the others. I would be really unhappy if a home health nurse suggested to my patient that there is something wrong with the combination and hinted that coumadin should be d/c'd. I would be ok if a home nurse told my patient, your INR is 13 so you should hold your coumadin until you talk to your doctor.

- pod

 

[dhb]

POD you're a really nice guy


ps: so you went from FP to OB to Gas???

 

[DutchgirlRN]

I suspect this patient is in need of both antiplatelet therapy and anticoagulation. She likely has coronary stents necessitating the antiplatelet therapies of Plavix and aspirin in addition to a-fib or a prosthetic valve requiring anticoagulation (coumadin). All three should be continued.

82 y/o CHF'er with A-fib who was hospitalized for CHF exacerbation.

The key is that you are dead wrong when you say that "a nurse knows a patient should not be taking asa, Plavix, and coumadin and a nurse knows why."

I admit that I stated it incorrectly from the beginning. You're correct that: There is no reason that a patient should not be taking all three. I would be really unhappy if a home health nurse suggested to my patient that there is something wrong with the combination and hinted that coumadin should be d/c'd. I told the patient because of her elevated INR she should not be taking the coumadin and that I was calling the doctors office. We have patients taking all three and as long as their INR is in the range the doctor wants it to be in, I wouldn't question it. I would be ok if a home nurse told my patient, your INR is 13 so you should hold your coumadin until you talk to your doctor.

- pod

Okay, I get you don't like nurses to be a patient advocate but I think it's better to call the doctor for an order to hold the coumadin than to have the patient hold it until she can talk to her doctor. Elderly people do not always understand fully what you're telling them and could wait for 2 weeks until their next appt with their doctor. I think I would have gotten ripped a new one if I had left the patient home without calling the doctor.

 

[Taurus]

I never asked to argue at the physician level. I asked you to explain, on a nursing level, why



You clearly are not going to admit that you are wrong, even though I gave you ample opportunity to do so. So it seems like you are blowing smoke when you say that you are one of the few who are willing to step up to the plate and admit when you are wrong. I am disappointed as I have spent some time reading some of your other posts and I thought that you might be one of the good ones.



Before I left primary care, I found that, in the office setting, the two were essentially interchangeable and both were equally good at keeping track of the things that I would typically forget/ screw up. The big difference was that my MA did not think that she understood medications and she would come and ASK ME what my plan was before telling a patient what she should do. My nurses tended to formulate a plan, inform the patient, and then tell me about it later. Most were pretty good at coming up with the same plan that I would even if they couldn't explain why.

From my perspective, it was more important for me to understand my MA's and nurses (and what their tendencies and limitations were) than to get hung up on whether I had an MA or a nurse working with me. BTW the best nurse/ MA I ever worked with was a certificate nurse.





As I have already said, I never mentioned a management strategy for this patient, or criticized yours. You are just too stubborn to realize/ admit it. I do not have enough information to formulate a plan fully, but making a few assumptions, here is what I would suggest you consider.

1. ASA and clopidogrel (Plavix) have no effect on INR and thus are not contraindicated in patients with supratherapeutic INR's or in patients who are simultaneously taking coumadin. Therefore, unless there is ongoing bleeding, the Plavix and ASA should be continued as prescribed.
   
2. I suspect this patient is in need of both antiplatelet therapy and anticoagulation. She likely has coronary stents necessitating the antiplatelet therapies of Plavix and aspirin in addition to a-fib or a prosthetic valve requiring anticoagulation (coumadin). All three should be continued.
   
3. Given the supratherapeutic INR, coumadin should be temporarily held and the patient referred to a physician to determine why her INR became so supratherapeutic and when to restart her coumadin and at what dose. The patient may require vitamin K therapy to reduce her INR or simply adjustment of her coumadin therapy. (a physician level argument)
   
4. If this patient came to me, I would refer her to one of my nurses who specialize in outpatient coumadin therapy. A nurse who manages coumadin regularly will be able to figure out the appropriate regimen more quickly than I will and I am not afraid to admit it. Obviously I would evaluate the patient and reverse the anticoagulation first if I thought it was necessary

The key is that you are dead wrong when you say that "a nurse knows a patient should not be taking asa, Plavix, and coumadin and a nurse knows why." There is no reason that a patient should not be taking all three. In fact we routinely have patients on all three because each has a different mechanism of action and that is complementary to the others. I would be really unhappy if a home health nurse suggested to my patient that there is something wrong with the combination and hinted that coumadin should be d/c'd. I would be ok if a home nurse told my patient, your INR is 13 so you should hold your coumadin until you talk to your doctor.

- pod

DutchgirlRN, it's easy to think that you fully understand the medicine because you've "been a nurse probably longer than [I've] been alive." You clearly did not. Don't feel bad, I doubt that the vast majority of nurses would.

What's scary is that this is an RN. Just imagine the arrogance and attitude that NP's and especially DNP's have regarding their clinical knowledge. I fear for the safety of patients everywhere.

This is why I strongly advocate informing the public, trial lawyers, and insurance executives on the differences in training, knowledge, and abilities between physicians and non-physicians like DNP's and CRNA's. Make it extremely risky and expensive for non-physicians to practice independently.

 

[periopdoc]

ps: so you went from FP to OB to Gas???

Gyn's do a surprising amount of primary care. Most of the anti-coag management that I was involved with was during pregnancy, thus I am relatively ignorant about the intricacies of coumadin management. I had a great MA who helped me learn the ins and outs of oral contraceptives and a wonderful NP who taught me about STD evaluation and management. I still correspond with the latter.

I was smart enough to stay away from FP as a career. I did do a 6-month Sub-Internship in a rural FP office during 3rd year. It was a special rotation for special students, although we were allowed to leave our helmets at home.

Prior to med school, I was a Firefighter/ EMT in rural Alaska and spent a fair amount of time with our physician preceptor in his FP. I thought it seemed great at the time, and I seriously planned on following in his footsteps. Then I got to MS-3 and figured out what it would really be like if I wasn't practicing in Lower Mucus Falls, AK. "Do you have a real problem? Ok I will refer you to someone else." If an FP is reading this, don't be insulted, after all I traded it to sit on a stool doing crosswords all day. 😉

- pod

 

[DutchgirlRN]

DutchgirlRN, it's easy to think that you fully understand the medicine because you've "been a nurse probably longer than [I've] been alive." You clearly did not. Don't feel bad, I doubt that the vast majority of nurses would.

What's scary is that this is an RN. Just imagine the arrogance and attitude that NP's and especially DNP's have regarding their clinical knowledge. I fear for the safety of patients everywhere.

This is why I strongly advocate informing the public, trial lawyers, and insurance executives on the differences in training, knowledge, and abilities between physicians and non-physicians like DNP's and CRNA's.

I have worked with NP's, CRNA's and PA's that think they are every bit the doctor and I totally agree it's scary. It's not only wrong but it's unethical in every way.

I have unintentionally conveyed my thoughts wrongly by saying nurses understand why. To be fair....I never said I fully understand medicine. What I should have said is that nurses know when to question an order because they understand the consequences of not doing so.

I have, in the normal course of my job, found orders such as Dilaudid 50mg IV Q 3 PRN and obviously knew it was an error. But there have been other orders such as orders for insulin that I have questioned and when questioning the doctor found that the doctor had made a mistake and thanked me for catching it. Nurses are not perfect, Doctors are not perfect and we have to work together. As a resident you're at the beginning of your career. Hopefully you won't make an error writing orders but if you do I hope there's a nurse who will question it and without judging you or reporting you. I am in the last years of my career and I have never reported a doctor until this past year. Long story.

 

[Arch Guillotti]

taken from another thread:

I've been a nurse for 34 years

🙄

periopdoc laid it out in a very nice manner. I would take heed of his words of wisdom.

 

[Coastie]

Originally Posted by Coastie

Sorry, I won't apoligize for being a patient advocate.

Dutchgirl,

I do appreciate you shunning allnurses.com and being at the other forum. At least you're up for some real discussion.

What do you mean, "patient advocate"? Advocate for what and in the face of whom? The entire team taking care of the patient, led by the physician, is supposed to advocate for the best care possible of the patient.

In reality, "patient advocate" is used as a term and philosophy by the majority of nurses to cause massive inefficiency within patient care delivery, primarily through useless questioning of the physician plan. A little book knowledge about pathophysiology combined with the attitude of being THE "patient advocate" goes a looooong way in decreasing the quality of healthcare our patients receive on a daily basis.

 

[periopdoc]

Okay, I get you don't like nurses to be a patient advocate but I think it's better to call the doctor for an order to hold the coumadin than to have the patient hold it until she can talk to her doctor. Elderly people do not always understand fully what you're telling them and could wait for 2 weeks until their next appt with their doctor. I think I would have gotten ripped a new one if I had left the patient home without calling the doctor.

And I would have been the first one to do the ripping. You did the right thing and you did exactly what I would expect. In my mind it goes something like this. "your INR is 13 so you should hold your coumadin until you talk to your doctor... here is the phone, talk to your doctor." I should have added that last part to my previous post.

You have me mixed up with somebody else as I like my nurses to advocate for the patient, when they truly advocate. Unfortunately, the idea of advocation has become more like obstruction. I can be very forgiving if a nurse needs some help understanding why I want to do something a certain way and asks me to explain. I can be quite the opposite if I find out that my orders were simply ignored because the nurse didn't understand or disagreed with my plan of care.

edited to add, I suspect that Dutchgirl is one of the good ones. I have read some of her stuff on this and another board and she seems to be the type of nurse that I would enjoy working with.

- pod

 

[Coastie]

Physicians do make errors, nurses catch them. It's a good thing when you don't deliver the 50 mg of Dilaudid.

Nurses at this point should call the doctor, and get things cleared up. What you often see, however, is that the "patient advocate" reports the doctor, for simple misunderstandings.

I've seen "patient advocates" get in the way during codes, bring up stupid issues of point and "judgement" on a physician's plan during family rounds in the ICU (don't even get me started the idiotic idea of family rounds), or go behind the physicians back by changing an order they felt was in error, to a truly life-threatening order, carry out said order, and then blame the physician who was a) never informed and b) never wrote the order.

I posted what we want from nurses in our daily practice. There may be minor bits to add, but my post above pretty much sums it up. 👍

I have worked with NP's, CRNA's and PA's that think they are every bit the doctor and I totally agree it's scary. It's not only wrong but it's unethical in every way.

I have unintentionally conveyed my thoughts wrongly by saying nurses understand why. To be fair....I never said I fully understand medicine. What I should have said is that nurses know when to question an order because they understand the consequences of not doing so.

I have, in the normal course of my job, found orders such as Dilaudid 50mg IV Q 3 PRN and obviously knew it was an error. But there have been other orders such as orders for insulin that I have questioned and when questioning the doctor found that the doctor had made a mistake and thanked me for catching it. Nurses are not perfect, Doctors are not perfect and we have to work together. As a resident you're at the beginning of your career. Hopefully you won't make an error writing orders but if you do I hope there's a nurse who will question it and without judging you or reporting you. I am in the last years of my career and I have never reported a doctor until this past year. Long story.

 

[Coastie]

You have me mixed up with somebody else as I like my nurses to advocate for the patient, when they truly advocate. Unfortunately, the idea of advocation has become more like obstruction.

Quoted for truth.

 

[DutchgirlRN]

I can be quite the opposite if I find out that my orders were simply ignored because the nurse didn't understand or disagreed with my plan of care. That kind of nurse should be written up and/or fired.

edited to add, I suspect that Dutchgirl is one of the good ones. I have read some of her stuff on this and another board and she seems to be the type of nurse that I would enjoy working with.

- pod

Thanks 😉

Physicians do make errors, nurses catch them. It's a good thing when you don't deliver the 50 mg of Dilaudid.

What you often see, however, is that the "patient advocate" reports the doctor, for simple misunderstandings. That is a nurse who has **** for brains.

I've seen "patient advocates" get in the way during codes, bring up stupid issues of point and "judgement" on a physician's plan during family rounds in the ICU (don't even get me started the idiotic idea of family rounds), or go behind the physicians back by changing an order they felt was in error, to a truly life-threatening order, carry out said order, and then blame the physician who was a) never informed and b) never wrote the order.

I posted what we want from nurses in our daily practice. There may be minor bits to add, but my post above pretty much sums it up. 👍

Believe me I've seen "patient advocate" nurses too and they freaking get on my nerves. If they change an order they should be fired. That's illegal. I've never heard of family rounds in ICU, how dumb is that and any nurse who knowingly follows out an order that she knows is life-threatening should lose her license.

 

[DutchgirlRN]

So Pod, enlighten me..... you've got my curiousity peaked, I work in IR. I do conscious sedation, push Lopressor, etc... Never heard of a CT anesthesia fellow.

 

[Coastie]

Thanks 😉



Believe me I've seen "patient advocate" nurses too and they freaking get on my nerves. If they change an order they should be fired. That's illegal. I've never heard of family rounds in ICU, how dumb is that and any nurse who knowingly follows out an order that she knows is life-threatening should lose her license.

👍

 

[DutchgirlRN]

Dutchgirl,

I do appreciate you shunning allnurses.com and being at the other forum. At least you're up for some real discussion.

Thank you. allnurses.com is a menace to the medical professions, they give out false information, particularly regarding anesthesiology. Actually I am the owner/administrator of www.justusnurses.com I encourage freedom of speech and purposeful debates as long as no one calls the other an idiot, *****, etc. Everyone has the right to their opinion whether it be right or wrong as long as it's offered relatively respectively. I have only ever banned one member and have never closed a thread. I appreciate this site for letting our discussion continue.

What do you mean, "patient advocate"? Advocate for what and in the face of whom? The entire team taking care of the patient, led by the physician, is supposed to advocate for the best care possible of the patient.

For me being a patient advocate is to look out for the patient and how I would want to be treated if I were in that hospital bed. I've seen nurses treat patients like they are nothing more than a paycheck. Don't get me wrong, I work for because I get paid but at the same time I try to look out for my patients, I make sure my patients understand exactly what is going to happen when they have their biopsy, pacemaker placement, heart cath. I find that their anxiousness is lessened when they know exactly what to expect. Sure the doctor explains it to them but they still want to know things they won't ask the doctor like "will I be conscious at all"? "what if I do feel pain, can you tell if I can't talk"? "What meds will I get"? "will you stay with me"? "how soon can I see my family afterwards"?

Once when I was at the OIC I had a patient who was a real mess because her doctor ordered a stat CT head/brain w/contrast and told her she may have a brain tumor. Now get this, the bump on her head was on the outside of the skull. This particular doctor is known for not being the brightest crayon in the box, anyway, the patient called her husband to come to the OIC and then he was crying too.

It was late on a Friday before a 3 day weekend. I talked to the radiologist while she was waiting to have her IV pulled and we kinda laughed about the doctor, it was a cyst, and the rad said "go ahead and tell her". I told the patient "you don't have cancer, relax and have a nice weekend" and said "talk to your doctor on Tuesday for the full results of your scan but everything is fine and that comes directly from the Radiologist that read your scan". They were so happy and I felt good that they didn't have to go 3 days waitng for results because they were such a mess.

The doctor called me the following Tuesday and said how dare you give my patient her results. I transferred him to the radiologist who said "I am an MD and I have every right to let the patient know the results of their scan. How dare you let these people suffer for 3 days over a simple cyst on the outside of her skull"! Seems the patient had talked to friends over the weekend who told her how incompetent her doctor was and she had called and cancelled her appointment. The person on the phone said "don't you need to know the results of your scan"? She said no I already know the results and said she wouldn't be back. I guess that's what pissed the doctor off but gees. To let a patient suffer for 3 days because a doctor told her a bump on the outside of her skull might be brain cancer, come on....

 

[Eta Carinae]

So Pod, enlighten me..... you've got my curiousity peaked, I work in IR. I do conscious sedation, push Lopressor, etc... Never heard of a CT anesthesia fellow.

 

[RedAnesthesia]

So Pod, enlighten me..... you've got my curiousity peaked, I work in IR. I do conscious sedation, push Lopressor, etc... Never heard of a CT anesthesia fellow.

CT does not stand for computer tomography, DutchgirlRN. It stands for cardiothoracic anesthesia fellow, which is probably why you have never heard of it.

 

[periopdoc]

CT does not stand for computer tomography, DutchgirlRN. It stands for cardiothoracic anesthesia fellow, which is probably why you have never heard of it.

Aww and I was just about to have some fun talking about how I am learning the intricacies of anesthetizing people for radiation exposure and how I avoid the MRI room since I am not specially trained for the effects of magnetism on anesthetic agents.

DGRN as he said I am doing additional training in anesthetizing people for open heart surgery and other surgery in the chest. Some of the coolest stuff that I have been doing lately is in the cardiac angio suite though. We are putting in minimally invasive aortic valves as part of a multicenter study. It is really amazing to replace someone's aortic valve through nothing more than a large femoral puncture. Hopefully Sebelius et al haven't ensured that this technology is DOA due to funding restrictions on interventional cards procedures.

- pod

 

[DutchgirlRN]

CT does not stand for computer tomography, DutchgirlRN. It stands for cardiothoracic anesthesia fellow, which is probably why you have never heard of it.

Thanks, That sounds interesting too. I would love to observe a CABG, transplant, anything cardiothoracic.

 

[DutchgirlRN]

Aww and I was just about to have some fun talking about how I am learning the intricacies of anesthetizing people for radiation exposure That's why I was kinda scratching my head! and how I avoid the MRI room since I am not specially trained for the effects of magnetism on anesthetic agents
- pod

Fortunately Proprofol is not magnetic 🙂 Unfortunately guns are. We had a ***** in the magnet with a gun, 5 bullets, no safety and a modified trigger so it would pull easier. OMG! A redneck straight down from the hills of Tennessee. He said "well I knew I couldn't have it in the MRI but I didn't think ya'll had turned the magnet on yet". He was freaking going in when all of a sudden he was sucked up into it. I ran in there because I thought with the sudden movement he may be having a seizure. At that time the MRI tech said "get the hell out and shut the magnet down".
It takes several days to get the magnet back up 👎

 

[Lonestar]

listen people. Arguing is not solving any problems. It only makes things worse.

We can sit here and pi$$ on each other all day without any benefit to anyone.

Or we could go to a tiddy bar. Who is with me??? 😀

 

[DutchgirlRN]

listen people. Arguing is not solving any problems. It only makes things worse.

Truth be told we were not arguing but rather debating and we came to a mutual understanding of respect for each others jobs.

 

[GasEmDee]

So Pod, enlighten me..... you've got my curiousity peaked, I work in IR. I do conscious sedation, push Lopressor, etc... Never heard of a CT anesthesia fellow.

HAHA. BEST POST OF THREAD! 👍

 

[GasEmDee]

Aww and I was just about to have some fun talking about how I am learning the intricacies of anesthetizing people for radiation exposure and how I avoid the MRI room since I am not specially trained for the effects of magnetism on anesthetic agents.

DGRN as he said I am doing additional training in anesthetizing people for open heart surgery and other surgery in the chest. Some of the coolest stuff that I have been doing lately is in the cardiac angio suite though. We are putting in minimally invasive aortic valves as part of a multicenter study. It is really amazing to replace someone's aortic valve through nothing more than a large femoral puncture. Hopefully Sebelius et al haven't ensured that this technology is DOA due to funding restrictions on interventional cards procedures.

- pod

Those transapical AVRs amaze me too. Kinda funny to think that the old valve is just squashed out of the way.

 

[ProRealDoc]

Thanks 😉



Believe me I've seen "patient advocate" nurses too and they freaking get on my nerves. If they change an order they should be fired. That's illegal. I've never heard of family rounds in ICU, how dumb is that and any nurse who knowingly follows out an order that she knows is life-threatening should lose her license.

duplicate

 

[ProRealDoc]

Thanks 😉



Believe me I've seen "patient advocate" nurses too and they freaking get on my nerves. If they change an order they should be fired. That's illegal. I've never heard of family rounds in ICU, how dumb is that and any nurse who knowingly follows out an order that she knows is life-threatening should lose her license.

I am glad you recognize the absurdity of such actions because someday YOU will be the patient on the receiving end of "patient advocacy" by nurses.

 

[ProRealDoc]

Thanks, That sounds interesting too. I would love to observe a CABG, transplant, anything cardiothoracic.

I knew CT anesthesia is sexy ****! Hey POD, I think you're about to get some. .

 

[DutchgirlRN]

I am glad you recognize the absurdity of such actions because someday YOU will be the patient on the receiving end of "patient advocacy" by nurses.

👍 you would be correct. There are nurses that drive me nuts with that crap. I know one doctor who is that way too and OMG we all avoid him like the plague! Even the other docs laugh at him behind his back

 

[GoodmanBrown]

Yeah, I love it how the RN's are up in arms about this. What goes around, comes around. I support expanding the scope of LPN's as well as MA's.

It's funny how adamant that the RN's are about not letting MA's give injections. See this thread regarding Nevada.

I'm sure I'm derailing the thread here by responding to the 3rd post, but I couldn't help it? You support a less trained nursing care provider increasing their scope of practice, yet your huge signature is filled with DNP horror? The irony here is completely staggering...

 

[Eta Carinae]

I'm sure I'm derailing the thread here by responding to the 3rd post, but I couldn't help it? You support a less trained nursing care provider increasing their scope of practice, yet your huge signature is filled with DNP horror? The irony here is completely staggering...

I'm sure Taurus will defend his point but I think it is far more conceivable for LPNs, MAs to expand the scope of their practice than for Nurses, whatever title they may use to camouflage their lack of medical training (DNP or whatever else) to attempt to function in the capacity of a physician.

there is a wide gulf ito medical knowledge and capabilities between nursing and medicine at an M.D. level that is insurmountable, whereas the basic tasks of nursing can be mastered by an LPN or MA especially with good physician supervision.

I think PAs serve a far more useful function than DNPs. and as far as I'm concerned, the accumulation of sub-par degrees (online PhDs and such) by such nurses only exacerbates the problem of increasing health care costs. Because while adding marginal or no additional value to the medical team or the healthcare system with their additional "degrees", they can command higher salaries and pursue avenues for independent practice.

 

[DutchgirlRN]

I think PAs serve a far more useful function than DNPs. and as far as I'm concerned, the accumulation of sub-par degrees (online PhDs and such) by such nurses only exacerbates the problem of increasing health care costs. Because while adding marginal or no additional value to the medical team or the healthcare system with their additional "degrees", they can command higher salaries and pursue avenues for independent practice.

I have worked with nurses who have gone on to get their NP license and they weren't even good nurses. I agree NP's should not be allowed to practice independently and I personally don't believe they should be allowed to write scripts beyond those required for simple maladies.

 

[Eta Carinae]

I have worked with nurses who have gone on to get their NP license and they weren't even good nurses. I agree NP's should not be allowed to practice independently and I personally don't believe they should be allowed to write scripts beyond those required for simple maladies.

YES! Consensus...👍

 

[GoodmanBrown]

I'm sure Taurus will defend his point but I think it is far more conceivable for LPNs, MAs to expand the scope of their practice than for Nurses, whatever title they may use to camouflage their lack of medical training (DNP or whatever else) to attempt to function in the capacity of a physician.

This is not intended as an insult, but: You think this way because you are a doctor.

there is a wide gulf ito medical knowledge and capabilities between nursing and medicine at an M.D. level that is insurmountable, whereas the basic tasks of nursing can be mastered by an LPN or MA especially with good physician supervision.

I typed in a quick google search of some combination of "Nursing outcomes bsn studies" or some such and came up with this page. Scroll to the section titled, "Recognizing Differences Among Nursing Program Graduates" for at least 11 studies (in reputable journals including JAMA) that show that high percentages of BSN nurses have better outcomes than straight RNs. So, replacing RNs with LPNs would likely show even greater adverse outcomes.

I think PAs serve a far more useful function than DNPs. and as far as I'm concerned, the accumulation of sub-par degrees (online PhDs and such) by such nurses only exacerbates the problem of increasing health care costs. Because while adding marginal or no additional value to the medical team or the healthcare system with their additional "degrees", they can command higher salaries and pursue avenues for independent practice.

You have more healthcare experience than I do, so I'll defer to your knowledge on this one. But ancedotally, I think a mid-level is a mid-level, and I'm not sure that fighting for one and against the other is really a consistent approach. In a town I lived in, there was a FM PA who had his own practice right next to a doctor's. It was a solo practice with only his name + PA-C on the sign. So, whatever doctor signed off on his charts had to have been doing so well after the patient had walked out of the building. Likewise, I've shadowed a cardiology PA and an EM PA who just gave a brief run-down of the patient's history to the MD. There was no real oversight IMHO, as they gave as much or as little info as desired and the MD just signed the chart. EMEDPA (a very experienced EM PA) speaks routinely of having hospitals treat NPs and PAs as similar workers with similar pay and privileges. He pulls solo EM shifts at night because he likes the autonomy. As shown above, PAs can certainly open up their own shop in most states and have physician oversight be a mere formality.

Also, do you know if DNPs are actually paid higher than regular NPs?

Final thought, I'm not actually pro-DNP or anything, though one might see my post in that light. The MD degree has a rigor that is clearly unmatched by NP (or DNP) training. I just couldn't help but be amazed at the response that Taurus gave. I just don't see how less education and training = similar competency in job skills, whether it be an LPN vs. an RN or a DNP vs. an MD.

 

[DutchgirlRN]

(in reputable journals including JAMA) that show that high percentages of BSN nurses have better outcomes than straight RNs. So, replacing RNs with LPNs would likely show even greater adverse outcomes.

IMHO Problem is that is such a generalization. I have worked with BSN, MSN, LPN's. There are LPN's that I would rather have care for me than some of the BSN's and MSN's. A degree does not a good nurse make. At least not from what I've seen.

 

[DutchgirlRN]

On the subject of NP's.....At Vanderbilt a person with a BS in any area, even Fashion Merchandising! can go to school there for 2 years and come out as a practicing NP. That should not be allowed. I've been a nurse for 34 years and I feel two years even for me would not be sufficient. Not that I would ever want to be a NP. I wouldn't.

As the saying goes, if I knew then what I know now, I would have gone straight into medical school and into infectious diseases. Especially while my parents were paying the bill. Ah well....tis not to be

 

[GoodmanBrown]

IMHO Problem is that is such a generalization. I have worked with BSN, MSN, LPN's. There are LPN's that I would rather have care for me than some of the BSN's and MSN's. A degree does not a good nurse make. At least not from what I've seen.

Completely agree that a BSN doesn't make a nurse a great nurse. But, with large studies, individual nurses are averaged out with each other, and the effect of the education itself can be better extrapolated. The studies pretty clearly show that the higher education level a nursing unit has, the better outcomes for patients.

 

[DutchgirlRN]

Completely agree that a BSN doesn't make a nurse a great nurse. But, with large studies, individual nurses are averaged out with each other, and the effect of the education itself can be better extrapolated. The studies pretty clearly show that the higher education level a nursing unit has, the better outcomes for patients.

Point taken, this one goes to you 😉

 

[Eta Carinae]

Originally Posted by GoodmanBrown
You think this way because you are a doctor.

as you will soon be, seeing as how you've been accepted to med school and all. I think this way because I've seen enough nurses try to pass themselves off as doctors.

And this isn't intended to villify all nurses. I actually value smart, competent and intelligent nurses who function within their capacity. On my surgery sub-I on a particularly Whipple surgeon's team, some of the greatest gifts to the medical team (at least from mine, the junior med student and the chief resident's perspectives) were the good nurses- because they spent more time with the patient and were extremely attentive to crucial trends in their vitals etc that we needed to keep track on but didn't have the time to do.

Originally Posted by GoodmanBrown
I typed in a quick google search of some combination of "Nursing outcomes bsn studies" or some such and came up with this page. Scroll to the section titled, "Recognizing Differences Among Nursing Program Graduates" for at least 11 studies (in reputable journals including JAMA) that show that high percentages of BSN nurses have better outcomes than straight RNs. So, replacing RNs with LPNs would likely show even greater adverse outcomes.

1. You'll soon learn that JAMA is not particularly considered a "reputable" journal. You would probably do better to reference articles from NEJM.
2. I'm not advocating replacing anyone with anyone else. My point was that it was far more conceivable if such a scenario were to arise than for any midlevel to attempt to function within the capacity of a physician.
You may read my post again if you wish. 😉
3. I'm sure your articles were great but I frankly didn't have the patience to go through nurses comparisons tonight. Perhaps spring break? No but really, I can only imagine then the outcome studies that have been done on midlevels attempting to function as physicians.

Originally Posted by GoodmanBrown
You have more healthcare experience than I do, so I'll defer to your knowledge on this one. But ancedotally, I think a mid-level is a mid-level, and I'm not sure that fighting for one and against the other is really a consistent approach.

You are wise beyond your...uh...your uh....training level? 😀

Originally Posted by GoodmanBrown
Also, do you know if DNPs are actually paid higher than regular NPs?

Actually yes I do. I have worked with at least two nurses who have increased their incomes by acquiring a D. 😀. Salary increase are somewhere around $12,000-$15,000 + the opportunity to take up faculty positions/titles in academic medical centers if desired.

Originally Posted by GoodmanBrown
Final thought, I'm not actually pro-DNP or anything, though one might see my post in that light. The MD degree has a rigor that is clearly unmatched by NP (or DNP) training. I just couldn't help but be amazed at the response that Taurus gave. I just don't see how less education and training = similar competency in job skills, whether it be an LPN vs. an RN or a DNP vs. an MD

again, you cannot compare those two scenarios.
completely different. You'll soon find out why.

 

[GoodmanBrown]

as you will soon be, seeing as how you've been accepted to med school and all. I think this way because I've seen enough nurses try to pass themselves off as doctors.

And this isn't intended to villify all nurses. I actually value smart, competent and intelligent nurses who function within their capacity. On my surgery sub-I on a particularly Whipple surgeon's team, some of the greatest gifts to the medical team (at least from mine, the junior med student and the chief resident's perspectives) were the good nurses- because they spent more time with the patient and were extremely attentive to crucial trends in their vitals etc that we needed to keep track on but didn't have the time to do.

1. You'll soon learn that JAMA is not particularly considered a "reputable" journal. You would probably do better to reference articles from NEJM.
2. I'm not advocating replacing anyone with anyone else. My point was that it was far more conceivable if such a scenario were to arise than for any midlevel to attempt to function within the capacity of a physician.
You may read my post again if you wish. 😉
3. I'm sure your articles were great but I frankly didn't have the patience to go through nurses comparisons tonight. Perhaps spring break? No but really, I can only imagine then the outcome studies that have been done on midlevels attempting to function as physicians.

You are wise beyond your...uh...your uh....training level? 😀

Actually yes I do. I have worked with at least two nurses who have increased their incomes by acquiring a D. 😀. Salary increase are somewhere around $12,000-$15,000 + the opportunity to take up faculty positions/titles in academic medical centers if desired.

again, you cannot compare those two scenarios.
completely different. You'll soon find out why.

Quick question. Do you support any use of NPs and PAs? Such as in situations with "strict" physician oversight and limited patient populations (i.e. non-complex patients)?