Minnesota RNs facing competition from less-qualified

[cchoukal]

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http://www.startribune.com/opinion/...rksLckD8EQDUoaEyqyP4O:DW3ckUiD3aPc:_Yyc:aUUsZ

This was an interesting article about how policy-makers are under pressure to allows LPNs to do more of what RNs have traditionally done, in order to save money.

It's interesting to me some of the parallels between their situation and ours, and also that the nursing board person in charge of drafting the proposal is an LPN.

 

[SleepIsGood]

http://www.startribune.com/opinion/...rksLckD8EQDUoaEyqyP4O:DW3ckUiD3aPc:_Yyc:aUUsZ

This was an interesting article about how policy-makers are under pressure to allows LPNs to do more of what RNs have traditionally done, in order to save money.

It's interesting to me some of the parallels between their situation and ours, and also that the nursing board person in charge of drafting the proposal is an LPN.

seriously...the parallel is ridiculous...CRNAs would love this.

 

[Taurus]

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.

 

[MDEntropy]

The big difference I see is this:

If you assume equality of outcomes in both cases, LPNs (vs. RNs) save hospitals money; CRNAs (vs. docs) do not.

I am not saying one should assume equality of outcomes, only comparing both situations given this assumption.

 

[turkeyjerky]

Eileen Weber is a nurse attorney

Watch out! The nurses have a new target:

 

[UMMS FMD]

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.

Hello, kettle? This is pot. You're black. 😀

 

[Taurus]

Hello, kettle? This is pot. You're black. 😀

It's good strategy. While they're distracted trying to expand their scope from the front, attack them from behind.

 

[militarymd]

The big difference I see is this:

If you assume equality of outcomes in both cases, LPNs (vs. RNs) save hospitals money; CRNAs (vs. docs) do not.

I am not saying one should assume equality of outcomes, only comparing both situations given this assumption.

It DOES...if you remove the "subsidy" which the majority of groups receive......some of which are 7 figures.

Don't kid yourself....they ARE less expensive in that they demand/command less $$$$ for right now.

 

[MDEntropy]

It DOES...if you remove the "subsidy" which the majority of groups receive......some of which are 7 figures.

Don't kid yourself....they ARE less expensive in that they demand/command less $$$$ for right now.

CRNA only groups expect a hospital subsidy too. CRNA's don't demand less dollars for unsupervised work or an equivalent amount of coverage and availability. They do command less in that it is tougher for them to compete in areas with high concentrations of physicians. If they were significantly less expensive, they would be much more competitive. Since they are not, given the choice, doctors win.

 

[militarymd]

CRNA only groups expect a hospital subsidy too. CRNA's don't demand less dollars for unsupervised work or an equivalent amount of coverage and availability. They do command less in that it is tougher for them to compete in areas with high concentrations of physicians. If they were significantly less expensive, they would be much more competitive. Since they are not, given the choice, doctors win.

The reason that anesthesiologists exist at all at hospitals...is because of medical staff by laws.....

 

[MDEntropy]

The reason that anesthesiologists exist at all at hospitals...is because of medical staff by laws.....

There is some truth in that statement but it applies to physicians of all specialties not just anesthesiologists.

 

[militarymd]

There is some truth in that statement but it applies to physicians of all specialties not just anesthesiologists.

not really.....WE don't bring ANY patients to the hospital....unless you are a pain doc....or a GREAT ccm doc to whom other primary care md's refer cases to.

 

[MDEntropy]

not really.....WE don't bring ANY patients to the hospital....unless you are a pain doc....or a GREAT ccm doc to whom other primary care md's refer cases to.

This is a different point. To that point, the same can be said about pathologists, radiologists, ER staff, medicine hospitalists, obstetric hospitalists, pediatric hospitalists...etc.

Coming back to your bylaws statement, they protect physicians in a variety of specialties from other health care professionals who would provide similar services.

Frankly, these are all digressions from the lack of savings that CRNA's provide to hospitals. They don't save hospitals money, and if they did, bylaws alone would be no explanation for why hospitals would not capitalize on these savings.

 

[Eta Carinae]

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.

Karma's really just a lovely, gentille lady...I don't know why she gets the "b"-word.

 

[militarymd]

This is a different point. To that point, the same can be said about pathologists, radiologists, ER staff, medicine hospitalists, obstetric hospitalists, pediatric hospitalists...etc.

Coming back to your bylaws statement, they protect physicians in a variety of specialties from other health care professionals who would provide similar services.

Frankly, these are all digressions from the lack of savings that CRNA's provide to hospitals. They don't save hospitals money, and if they did, bylaws alone would be no explanation for why hospitals would not capitalize on these savings.

boy...you are THICK...

those OTHER specialists do not command subsidies like anesthesiologists do.

or do YOU know better....do you have data to dispute that?

CRNA's Do NOT command subsidies like anesthesiologists do....or do YOU have data to dispute that also?

if you do ....let us know....along with your practice management experience....which I have been asking about for what ...5 years now?

Otherwise...pure and simple.... crna's cost hospital's less when a subsidy is involved....and as we all know...that is most of the time.

Hospital don't use crna's because, fortunately for us, the medical staff usually expects the presence of anesthesiologists.

 

[MDEntropy]

boy...you are THICK...

those OTHER specialists do not command subsidies like anesthesiologists do.

or do YOU know better....do you have data to dispute that?

CRNA's Do NOT command subsidies like anesthesiologists do....or do YOU have data to dispute that also?

if you do ....let us know....along with your practice management experience....which I have been asking about for what ...5 years now?

Otherwise...pure and simple.... crna's cost hospital's less when a subsidy is involved....and as we all know...that is most of the time.

Hospital don't use crna's because, fortunately for us, the medical staff usually expects the presence of anesthesiologists.

Stick to the issues.

Why are you asking me to provide data to dispute a statement I made previously?

Did you not read my previous statement?

I will say it again.

CRNA only groups expect a hospital subsidy too. CRNA's don't DEMAND less dollars for unsupervised work or an equivalent amount of coverage and availability. They do COMMAND less in that it is tougher for them to compete in areas with high concentrations of physicians. If they were significantly less expensive, they would be much more competitive. Since they are not, given the choice, doctors win.

 

[militarymd]

The big difference I see is this:

If you assume equality of outcomes in both cases, LPNs (vs. RNs) save hospitals money; CRNAs (vs. docs) do not.

I am not saying one should assume equality of outcomes, only comparing both situations given this assumption.

It DOES...if you remove the "subsidy" which the majority of groups receive......some of which are 7 figures.

Don't kid yourself....they ARE less expensive in that they demand/command less $$$$ for right now.

Stick to the issues.

Why are you asking me to provide data to dispute a statement I made previously?

Did you not read my previous statement?

I will say it again.

CRNA only groups expect a hospital subsidy too. CRNA's don't DEMAND less dollars for unsupervised work or an equivalent amount of coverage and availability. They do COMMAND less in that it is tougher for them to compete in areas with high concentrations of physicians. If they were significantly less expensive, they would be much more competitive. Since they are not, given the choice, doctors win.

I AM sticking with the issues...it is you who are unable to comprehend what I'm telling you.

CRNA's ARE cheaper when a subsidy is involved ...in that they DO NOT command/demand the same amount.

I'm asking you to show me an example of where a crna is commanding the SAME or HIGHER subsidy than a md group.....seeing how you have this great practice management or whatever experience that you appear to have but won't share.

You are right that CRNA's cost the same if NO subsidy is involved.

Everyone knows my experience, and IN my experience CRNA's are paid LESS than md's......LESS dollars per anesthetizing location per hour in overall cost to a hospital that is SUBSIDIZING the anesthesia department.

You appear to disagree. You SAID that they cost the same....well...I say you are wrong....and I demand an example....show me...show us...other readers of this board.

 

[MDEntropy]

I AM sticking with the issues...it is you who are unable to comprehend what I'm telling you.

CRNA's ARE cheaper when a subsidy is involved ...in that they DO NOT command/demand the same amount.

I'm asking you to show me an example of where a crna is commanding the SAME or HIGHER subsidy than a md group.....seeing how you have this great practice management or whatever experience that you appear to have but won't share.

You are right that CRNA's cost the same if NO subsidy is involved.

Everyone knows my experience, and IN my experience CRNA's are paid LESS than md's......LESS dollars per anesthetizing location per hour in overall cost to a hospital that is SUBSIDIZING the anesthesia department.

You appear to disagree. You SAID that they cost the same....well...I say you are wrong....and I demand an example....show me...show us...other readers of this board.

I am not sure why I end up repeating myself...repeatedly.

I don't have data to dispute my own statement. I just said that...and then you ask me for the same thing again....data to dispute my own statement.

I still don't have it.

As for example where it has become clear that CRNA's and MD's actually cost about the same...Kaiser Permanente. In some cases it has turned that CRNA's are actually more expensive.

I am sure you are aware that there is much bigger delta between CRNA and MD salary's in the south/southeastern US than elsewhere.

 

[jwk]

boy...you are THICK...

those OTHER specialists do not command subsidies like anesthesiologists do.

Huh? Hospitalists=hospital employee=salary+benefits=subsidy.

 

[militarymd]

Huh? Hospitalists=hospital employee=salary+benefits=subsidy.

as mde alluded to, many receive subsidies....but overall, the anesthesia departments are at the top of the list.

 

[militarymd]

I am not sure why I end up repeating myself...repeatedly.

I don't have data to dispute my own statement. I just said that...and then you ask me for the same thing again....data to dispute my own statement.

I still don't have it.

As for example where it has become clear that CRNA's and MD's actually cost about the same...Kaiser Permanente. In some cases it has turned that CRNA's are actually more expensive.

I am sure you are aware that there is much bigger delta between CRNA and MD salary's in the south/southeastern US than elsewhere.

In a situation where mds and crnas are BOTH employed....crnas MAY actually be MORE expensive than md's depending on the type of payers that exist in the area of EMPLOYMENT.

However, in the VAST majority of cases, BECAUSE of the "subsidy" from the hospital to the anesthesia department which mostly goes into the md's pockets.....CRNA's are less expensive...

 

[DutchgirlRN]

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.

Don't be so quick to speak about what you know nothing of.....

Doctors like MA's because they can do everything the nurse can do for far less than a nurses salary i.e. they're cheaper to have in the office.

There's one big difference. If the nurse doesn't something wrong it's her license that is in jeopardy. If the MA does something wrong it's the doctors license that is in jeopardy. Everything an MA does is done under the license of the ordering physician. So who do you want giving meds under your license? 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.

MA's are notorious for saying they are a "nurse" it's against the law to use the term nurse referring to yourself if you are indeed not a nurse. "Nurse" is a legally protected title. Patient believe MA's are nurses and take everything they say as the truth. You have no idea how many patients I've seen in home health who have been seriously compromised because the "nurse" at their doctors office told them it was ok to take this med with that med. Consider this a valuable piece of advise!

 

[IN2B8R]

as mde alluded to, many receive subsidies....but overall, the anesthesia departments are at the top of the list.

MilitaryMD: I can add to this discussion by saying that at my institution, where there is a high medicare/medicaid payor mix, the CT surgeons and radiologists (a group of greater than 14 radiologists) get a far bigger subsidy than does the anesthesia group. The allocation of the subsidy (around my neck of the woods) has largely to do with the availability of providers/specialists, payor mix, and just a group's God-given connections with the administration. On the whole, though, I do agree with you that anesthesiologists countrywide are usually on the subsidy bandwagon well before others are.... This, as you well know, has largely to do with the low gov't reimbursement rates that we get through medicare/medicaid, as well as from sh*ty private insurance carriers that love to emulate gov't reimbursement rates.

 

[Taurus]

Don't be so quick to speak about what you know nothing of.....

Doctors like MA's because they can do everything the nurse can do for far less than a nurses salary i.e. they're cheaper to have in the office.

There's one big difference. If the nurse doesn't something wrong it's her license that is in jeopardy. If the MA does something wrong it's the doctors license that is in jeopardy. Everything an MA does is done under the license of the ordering physician. So who do you want giving meds under your license? 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.

MA's are notorious for saying they are a "nurse" it's against the law to use the term nurse referring to yourself if you are indeed not a nurse. "Nurse" is a legally protected title. Patient believe MA's are nurses and take everything they say as the truth. You have no idea how many patients I've seen in home health who have been seriously compromised because the "nurse" at their doctors office told them it was ok to take this med with that med. Consider this a valuable piece of advise!

As soon as the **** hits the fan, you think that the nurses voluntarily admit that they screwed up? Lol. They do their best to blame the physician or someone else. It's CYA and I see it all the time in the hospital.

That's why I say be very careful of what you teach someone and what you allow them to do. It doesn't matter if they're an MA or nurse.

 

[deleted126335]

In a situation where mds and crnas are BOTH employed....crnas MAY actually be MORE expensive than md's depending on the type of payers that exist in the area of EMPLOYMENT.

However, in the VAST majority of cases, BECAUSE of the "subsidy" from the hospital to the anesthesia department which mostly goes into the md's pockets.....CRNA's are less expensive...

Depends on how you do the math when calling crnas less "expensive" than mds. If you are just talking about payroll for an anesthesia department, I agree with you. But "costs" also include productivity, efficiency, utilization of consultants, costs of cancellations, value of associated services, costs of delays, complications and litigation.

 

[Coastie]

The mechanics of an injection..what might those be?

The "theory" behind taking a weight/height/vitals, and a pre-printed sheet for them to fill out...what is that, exactly?

We are talking about MA's vs Nurses in an office setting..BTW, most of the best nurses don't even have college degrees, they are the older ones with certificates, and they will tell you that the "degreed" nurses aren't always the best.

No MA or Nurse, for that matter, will tell my patients what meds are ok to take together at home, etc. The example you used would be inappropriate for an MA or Nurse. The only person who should be dictating medication usage is a Medical Doctor.

Don't be so quick to speak about what you know nothing of.....

Doctors like MA's because they can do everything the nurse can do for far less than a nurses salary i.e. they're cheaper to have in the office.

There's one big difference. If the nurse doesn't something wrong it's her license that is in jeopardy. If the MA does something wrong it's the doctors license that is in jeopardy. Everything an MA does is done under the license of the ordering physician. So who do you want giving meds under your license? 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.

MA's are notorious for saying they are a "nurse" it's against the law to use the term nurse referring to yourself if you are indeed not a nurse. "Nurse" is a legally protected title. Patient believe MA's are nurses and take everything they say as the truth. You have no idea how many patients I've seen in home health who have been seriously compromised because the "nurse" at their doctors office told them it was ok to take this med with that med. Consider this a valuable piece of advise!

 

[DutchgirlRN]

as soon as the **** hits the fan, you think that the nurses voluntarily admit that they screwed up? Lol. They do their best to blame the physician or someone else. It's cya and i see it all the time in the hospital.
i obviously can't speak for all nurses but yes, when i mess up i do own up to it. It's called ethics and being able to live with yourself. I don't blame others for my mistakes.
that's why i say be very careful of what you teach someone and what you allow them to do. It doesn't matter if they're an ma or nurse.
if you teach a nurse, she is responsible, it's his/her license that is in jeopardy. If you teach an ma and they mess up, the physician is responsible. Ma's work under the physicians license.

we are talking about ma's vs nurses in an office setting..btw, most of the best nurses don't even have college degrees, they are the older ones with certificates, and they will tell you that the "degreed" nurses aren't always the best.
no that's not true. There are no certificate nurses. There are nurses with degrees and there are still some nurses out there who earned their degree in a diploma program where they went to school at the hospital and did earn an asn or bsn.

i've met good nurses at all levels. Asn, bsn, msn makes little difference. It's having ethics, compassion, patient advocate skills, time management skills and good clinical skills. Never being afraid to ask for help or say i don't know how to do that. Speaking up when you make a mistake. Portray professionalism, these things add up to a good nurse no matter how many years they have practiced.

no ma or nurse, for that matter, will tell my patients what meds are ok to take together at home, etc. The example you used would be inappropriate for an ma or nurse. The only person who should be dictating medication usage is a medical doctor.
but don't you understand it doesn't work that way in all doctors offices. A nurse knows a patient shouldn't be taking asa, plavix and coumadin and a nurse knows why. I had a home health patient with an inr of 13.2 i reviewed her meds and she was taking all 3 of those meds. She told me when she got home from the hosp her coumadin was no longer on her med list so she called the office and the "nurse" julia told her to continue to take the coumadin. I called the office to learn that "nurse" julia was an ma with 6 months experience.

 

[Paseo Del Norte]

As soon as the **** hits the fan, you think that the nurses voluntarily admit that they screwed up? Lol.

Some do. I have fessed up and even called the physician my self to report on errors.


They do their best to blame the physician or someone else. It's CYA and I see it all the time in the hospital.

The same can be said of some physicians. However, any provider worth their weight will admit when they are wrong.


That's why I say be very careful of what you teach someone and what you allow them to do. It doesn't matter if they're an MA or nurse.

Admitting mistakes is something that should be learned in early grade school. If not, you fail regardless of your profession as an adult.

 

[periopdoc]

A nurse knows a patient shouldn't be taking asa, plavix and coumadin and a nurse knows why. I had a home health patient with an inr of 13.2 i reviewed her meds and she was taking all 3 of those meds.

Hmm, I must have missed that part of medical school. Could you enlighten me about why a patient should not be taking aspirin, Plavix, and coumadin simultaneously?

- pod

 

[Eta Carinae]

Hmm, I must have missed that part of medical school. Could you enlighten me about why a patient should not be taking aspirin, Plavix, and coumadin simultaneously?

- pod

VERY, VERY NICE CATCH!

 

[tncekm]

MA's are notorious for saying they are a "nurse" it's against the law to use the term nurse referring to yourself if you are indeed not a nurse. "Nurse" is a legally protected title.

Same goes for MD and Doctor (in a hospital setting) in many states (should be all states). DNP's will often present themselves as "Doctor So-and-so", effectively fooling the unsuspecting patient into thinking they're being seen by a physician.

Patient believe MA's are nurses and take everything they say as the truth. You have no idea how many patients I've seen in home health who have been seriously compromised because the "nurse" at their doctors office told them it was ok to take this med with that med. Consider this a valuable piece of advise!

Sounds like an DNP pretending to be an MD situation to me.

The only difference I'm seeing is that there seems to be a legitimate reason to expand MA scope of practice, which is opposite the case with NP's trying to eat up MD turf.

 

[DutchgirlRN]

Hmm, I must have missed that part of medical school. Could you enlighten me about why a patient should not be taking aspirin, Plavix, and coumadin simultaneously?

- pod

VERY, VERY NICE CATCH!

No, if you had read my post you would have read that at the time the patients INR was 13.2 🙄 I would dare say even the dumbest of doctors wouldn't add coumadin to this patients med list?

 

[Eta Carinae]

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

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.

Consider this a valuable piece of advise!

Hmm, I must have missed that part of medical school. Could you enlighten me about why a patient should not be taking aspirin, Plavix, and coumadin simultaneously?

- pod

DutchRN
Your statement as above was that a patient should not be taking all three- plavix, asa and coumadin.

There are a few reasons a patient would have an INR of 13.2
1) congenital deficiencies of Factors II, V, VII, X
2) Severe liver dysfunction
3) Vitamin K Deficiency- secondary to chronic antibiotic therapy, malnutrition, pancreatic disease, CF, Liver dysfunction or occasionally chronic malabsorptive diseases such as Crohn's
4) Warfarin therapy
5) Rarely presence of lupus anticoagulant- in which case there would also be a prolonged PTT +/- paradoxical hx of clotting/embolism/CVA etc.

I'm guessing from this medication list that the patient had a history of ACS/MI/DVT/PE/CVA or any other hypercoagulable anomaly + risk for future coronary event.

Hemostasis involves 2 major systems and one relatively minor one
2 major:
i. Platelets:
-Primary Hemostasis provided by Platelet plug;
-primary player in arterial hemostasis.

ii. The Coagulation Cascade:
-Secondary hemostasis provided by the activation of coagulation factors to converge on THROMBIN formation with a FIBRIN mesh.
-Primary player in Venous hemostasis

1 minor:
Vascular Wall/Endothelial Cell integrity/physiology

Most attempts to treat a patient with the presumed history yours had (based on the medication list) will attempt to address
BOTH COMPONENTS OF THE MAJOR HEMOSTASIS CONTRIBUTORS:

Platelets - to avoid arterial thromboses which are the main culprits of ACSs/MIs/CVAs

AND

The Coagulation System - to avoid venous thromboses which are the main culprits of DVTs/PEs

ASA and Plavix address platelets (a very separate system), hence decrease the risk for MIs/CVAs

Warfarin addresses the coagulation system

So giving all three meds IS required in certain patients.

EVEN the DUMBEST NURSE SHOULD KNOW ALL THAT!!!!

 

[Eta Carinae]

If that was too much information for you, I have three solutions:

1) Take the MCAT, go to med school and spend more time learning real medicine
2) Stop pretending to be the doc, you're an RN
3) Don't attempt to insult yourself in a physicians' forum

 

[Eta Carinae]

DutchRN
Your statement as above was that a patient should not be taking all three- plavix, asa and coumadin.

There are a few reasons a patient would have an INR of 13.2
1) congenital deficiencies of Factors II, V, VII, X
2) Severe liver dysfunction
3) Vitamin K Deficiency- secondary to chronic antibiotic therapy, malnutrition, pancreatic disease, CF, Liver dysfunction or occasionally chronic malabsorptive diseases such as Crohn's
4) Warfarin therapy
5) Rarely presence of lupus anticoagulant- in which case there would also be a prolonged PTT +/- paradoxical hx of clotting/embolism/CVA etc.

I'm guessing from this medication list that the patient had a history of ACS/MI/DVT/PE/CVA or any other hypercoagulable anomaly + risk for future coronary event.

Hemostasis involves 2 major systems and one relatively minor one
2 major:
i. Platelets:
-Primary Hemostasis provided by Platelet plug;
-primary player in arterial hemostasis.

ii. The Coagulation Cascade:
-Secondary hemostasis provided by the activation of coagulation factors to converge on THROMBIN formation with a FIBRIN mesh.
-Primary player in Venous hemostasis

1 minor:
Vascular Wall/Endothelial Cell integrity/physiology

Most attempts to treat a patient with the presumed history yours had (based on the medication list) will attempt to address
BOTH COMPONENTS OF THE MAJOR HEMOSTASIS CONTRIBUTORS:

Platelets - to avoid arterial thromboses which are the main culprits of ACSs/MIs/CVAs

AND

The Coagulation System - to avoid venous thromboses which are the main culprits of DVTs/PEs

ASA and Plavix address platelets (a very separate system), hence decrease the risk for MIs/CVAs

Warfarin addresses the coagulation system

So giving all three meds IS required in certain patients.

EVEN the DUMBEST NURSE SHOULD KNOW ALL THAT!!!!

A person like you would need to hear it twice, RN

 

[Coastie]

Why bother teaching a nurse medicine? She doesn't need to know this stuff.

The only thing a nurse needs to know is nursing. The key to this problem is that, as a nurse, she shouldn't give medical advice. She should leave this up to the doctor.

DutchRN
Your statement as above was that a patient should not be taking all three- plavix, asa and coumadin.

There are a few reasons a patient would have an INR of 13.2
1) congenital deficiencies of Factors II, V, VII, X
2) Severe liver dysfunction
3) Vitamin K Deficiency- secondary to chronic antibiotic therapy, malnutrition, pancreatic disease, CF, Liver dysfunction or occasionally chronic malabsorptive diseases such as Crohn's
4) Warfarin therapy
5) Rarely presence of lupus anticoagulant- in which case there would also be a prolonged PTT +/- paradoxical hx of clotting/embolism/CVA etc.

I'm guessing from this medication list that the patient had a history of ACS/MI/DVT/PE/CVA or any other hypercoagulable anomaly + risk for future coronary event.

Hemostasis involves 2 major systems and one relatively minor one
2 major:
i. Platelets:
-Primary Hemostasis provided by Platelet plug;
-primary player in arterial hemostasis.

ii. The Coagulation Cascade:
-Secondary hemostasis provided by the activation of coagulation factors to converge on THROMBIN formation with a FIBRIN mesh.
-Primary player in Venous hemostasis

1 minor:
Vascular Wall/Endothelial Cell integrity/physiology

Most attempts to treat a patient with the presumed history yours had (based on the medication list) will attempt to address
BOTH COMPONENTS OF THE MAJOR HEMOSTASIS CONTRIBUTORS:

Platelets - to avoid arterial thromboses which are the main culprits of ACSs/MIs/CVAs

AND

The Coagulation System - to avoid venous thromboses which are the main culprits of DVTs/PEs

ASA and Plavix address platelets (a very separate system), hence decrease the risk for MIs/CVAs

Warfarin addresses the coagulation system

So giving all three meds IS required in certain patients.

EVEN the DUMBEST NURSE SHOULD KNOW ALL THAT!!!!

A person like you would need to hear it twice, RN

 

[Coastie]

.

Originally Posted by RN
no that's not true. There are no certificate nurses. There are nurses with degrees and there are still some nurses out there who earned their degree in a diploma program where they went to school at the hospital and did earn an asn or bsn.

Yes, there are certificate nurses. There are even certificate CRNAs.

i've met good nurses at all levels. Asn, bsn, msn makes little difference. It's having ethics, compassion, patient advocate skills, time management skills and good clinical skills. Never being afraid to ask for help or say i don't know how to do that. Speaking up when you make a mistake. Portray professionalism, these things add up to a good nurse no matter how many years they have practiced.

Patient advocate skills? What are those? Do you mean the excuse nurses have to question every action by a physician? Do you mean the times where, when a nurse doesn't understand a medical decision, she obstructs patient care in the name of being a "patient advocate"? Yes, I'm very familiar with those "skills". The abuse of this principle is one of the biggest contributing factors to inefficiency on the medical floors today. Funny, the older nurses recognize this, however the younger ones usually do not.

but don't you understand it doesn't work that way in all doctors offices. A nurse knows a patient shouldn't be taking asa, plavix and coumadin and a nurse knows why. I had a home health patient with an inr of 13.2 i reviewed her meds and she was taking all 3 of those meds. She told me when she got home from the hosp her coumadin was no longer on her med list so she called the office and the "nurse" julia told her to continue to take the coumadin. I called the office to learn that "nurse" julia was an ma with 6 months experience.

Why shouldn't they be taking those three medicines? That is different than the INR being high. Consult the attending physician on the medical matter. As to why a doctor has MA's who are giving pseudo-medical advice, I can't speak to that other than shame on the physician who has that setup, be it nurse or MA giving the inappropriate advice.

 

[Taurus]

as soon as the **** hits the fan, you think that the nurses voluntarily admit that they screwed up? Lol. They do their best to blame the physician or someone else. It's cya and i see it all the time in the hospital.

i obviously can't speak for all nurses but yes, when i mess up i do own up to it. It's called ethics and being able to live with yourself. I don't blame others for my mistakes.

that's why i say be very careful of what you teach someone and what you allow them to do. It doesn't matter if they're an ma or nurse.

if you teach a nurse, she is responsible, it's his/her license that is in jeopardy. If you teach an ma and they mess up, the physician is responsible. Ma's work under the physicians license.

Any physician who runs their practice relying on nursing staff to do the right thing and admit when they're wrong won't stay in business for long. Nurses, understandably, will deflect blame as much as they can because they don't want to lose their jobs or licenses.

Read more about incompetent nurses.

Inept nurses free to work in new locales

This thread chronicles article after article of not only inept nurses but also incompetent nursing boards.​

You run a practice by assuming if one of the staff members screws up how do you avoid being sued out of business. The answer is you have to carefully consider what you allow them to do. The "safe" things you let them do, ie, write down list of meds, take vitals, give some shots. The riskier stuff you hire a PA or another physican to do, ie, procedures, getting thorough H&P.

 

[coprolalia]

In the spirit of "too much content", not enough "boiling off the fat", deciding how much we want to read before we make up our minds, and belaboring a point... (re: that article....)

I'm just gonna say this. I read about the first 4-5 paragraphs. And, while I agree in principle with the idea that allowing crappy nurses to continue to practice is wrong, these were home nursing incidences where there is little to no additional supervision and no immediately available help, should it be needed. That's a large part of the problem.

And, in both of those cases with the first nurse, she may have unwittingly done society a favor. Yeah, I said it. I mean, in the second case report on this nurse the parents weren't even at home with their own child. Shows how much love they had for that baby. They entrusted the care of the baby to that woman, and they were probably (secretly) grateful for the outcome.

-copro

 

[periopdoc]

No, if you had read my post you would have read that at the time the patients INR was 13.2 🙄 I would dare say even the dumbest of doctors wouldn't add coumadin to this patients med list?

Trust me, I read your post very carefully and measured my response specifically to give you the opportunity to correct yourself. I am trying to make it simple.

If you would like me to requote...

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

So I ask again, why shouldn't a patient be taking asa, plavix, and coumadin simultaneously?

- pod

 

[coprolalia]

They entrusted the care of the baby to that woman, and they were probably (secretly) grateful for the outcome.

I call this the "Trailer-park Trifecta"...

(1) Have baby outta wedlock, get everything paid for by society. Ka-ching!


(2) Baby has medical problems, get to have someone else take care of baby, paid for by Medicaid, while still collecting check. Ka-ching!


(3) Someone screws-up and kills baby you never see, don't really care about, or otherwise allow to interfere with your regular parasitic life sucking off of society's tit... hire lawyer and sue for millions for pain and suffering. JACKPOT!

It should be no wonder why some of us feel this country is going down the sh*tter! There's only so long any society can sustain these kinds of SUBSIDIZED BEHAVIORS!

-copro

 

[deleted128562]

Back onto the original subject.... 🙂

The nursing lobby seems to have originated the argument that a provider shortage should be justification for allowing someone less qualified to operate in the same capacity. So it should be no surprise that LPN's, essentially part of the same lobby, would see a shortage of RN's and think "hey, we ought to get expanded practice rights!"

The sweet irony would be delightful if not for the fact that it's so darn bad for the patient. NP's are not physicians. LPN's are not RN's. There are drastic differences in training, and pretending or stating otherwise is about as sane and about as true as a 500 pound woman telling her friends that she's dating Brad Pitt.

Still, with so many new grad RN's deciding that nursing is beneath them and moving directly on to NP or CRNA school, the RN shortage will worsen and I predict that more and more states will look at allowing LPN's and MA's to do more. It is rare for me to meet a new nursing grad who actually wants to do nursing anymore. Most want to go on to NP or CRNA school, many without ever wanting to work a single day as an RN.

 

[fakin' the funk]

Could you enlighten me about why a patient should not be taking aspirin, Plavix, and coumadin simultaneously?

Hopefully we can enlighten the pharmacists at my hospital, who also required convincing that this is an OK combination. 😀

 

[DutchgirlRN]

Trust me, I read your post very carefully and measured my response specifically to give you the opportunity to correct yourself. I am trying to make it simple.

If you would like me to requote...
So I ask again, why shouldn't a patient be taking asa, plavix, and coumadin simultaneously?

- pod

Ok, so you have patient with an INR of 13.2 and you want them to continue to take ASA, Plavix and Coumadin on a daily basis? Let me know where you practice.....I'll stay far away 😉

 

[coprolalia]

Ok, so you have patient with an INR of 13.2 and you want them to continue to take ASA, Plavix and Coumadin on a daily basis? Let me know where you practice.....I'll stay far away 😉

Okay, I'll pile on...

We all hope you know that we fully understand what you are trying to do here. You're moving the goalposts. Changing the subject. Diverting the question.

Don't interpret the non-clinical bickering on this forum between physicians to mean that some stupid upstart nurse can come here and play games.

What would one do with an INR for 13.2?

I can only tell you what you'd do: you'd call the doctor to figure out and tell you what to do.

-copro

 

[2win]

Okay, I'll pile on...

We all hope you know that we fully understand what you are trying to do here. You're moving the goalposts. Changing the subject. Diverting the question.

Don't interpret the non-clinical bickering on this forum between physicians to mean that some stupid upstart nurse can come here and play games.

What would one do with an INR for 13.2?

I can only tell you what you'd do: you'd call the doctor to figure out and tell you what to do.

-copro

"I can only tell you what you'd do: you'd call the doctor to figure out and tell you what to do."

Copro - please be careful - she will call Omar Sharif or Pelosi at home because she reads the other thread too..and she'll ask about INR next time.

 

[periopdoc]

Ok, so you have patient with an INR of 13.2 and you want them to continue to take ASA, Plavix and Coumadin on a daily basis? Let me know where you practice.....I'll stay far away 😉

I never mentioned my management strategy for this patient. I asked you to explain a specific statement that you made.

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

so please tell me why a patient should not be taking these three medications simultaneously or live up to your word...

i obviously can't speak for all nurses but yes, when i mess up i do own up to it. It's called ethics and being able to live with yourself. I don't blame others for my mistakes

and admit that your statement was a mistake, even a simple grammatical one, but it sound like you are trying to blow some smoke somewhere.



- pod

p.s. I would be happy to discuss my management strategy for this patient if you ask me to, and you provide me with the necessary details.

 

[coprolalia]

"I can only tell you what you'd do: you'd call the doctor to figure out and tell you what to do."

Copro - please be careful - she will call Omar Sharif or Pelosi at home because she reads the other thread too..and she'll ask about INR next time.

2win,

I wasn't sure about you for a long time... still am not quite... but, you're winning me over, slowly but surely.

👍

-copro

 

[dhb]

Ok, so you have patient with an INR of 13.2 and you want them to continue to take ASA, Plavix and Coumadin on a daily basis? Let me know where you practice.....I'll stay far away 😉

Haha nurses crack me up. So tell us what will correct faster the coagulation or the platelet function??

 

[DutchgirlRN]

and admit that your statement was a mistake, even a simple grammatical one, but it sound like you are trying to blow some smoke somewhere.
- pod
p.s. I would be happy to discuss my management strategy for this patient if you ask me to, and you provide me with the necessary details.

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?

Haha nurses crack me up. So tell us what will correct faster the coagulation or the platelet function??

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.