N.P vs MD/DO ?

[DutchgirlRN]

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I work with some wonderful PA's and NP's. They know they are not doctors and know their limitations. I have seen those who do not know their limitations and they are damm dangerous.

What I don't understand is schools like Vanderbilt University. You can have a BS in any subject and go to school there for 2 years and come out as a NP. Do these people actually get NP jobs?

I've been a nurse for 34 years and I feel like even I would need a miminum of 2 years of additional schooling to do the job of an NP.

 

[lawguil]

I work with some wonderful PA's and NP's. They know they are not doctors and know their limitations. I have seen those who do not know their limitations and they are damm dangerous.

What I don't understand is schools like Vanderbilt University. You can have a BS in any subject and go to school there for 2 years and come out as a NP. Do these people actually get NP jobs?

I've been a nurse for 34 years and I feel like even I would need a miminum of 2 years of additional schooling to do the job of an NP.

DutchgirlRN, I admire your loyalty to work as an RN. I truly respect the hard work of traditional bedside nurses. I consider bedside nursing to be one of the noblest careers and an important role in healthcare. The old nurses epitomize what nursing should be in my opinion.

 

[DutchgirlRN]

DutchgirlRN, I admire your loyalty to work as an RN. I truly respect the hard work of traditional bedside nurses. I consider bedside nursing to be one of the noblest careers and an important role in healthcare. The old nurses epitomize what nursing should be in my opinion.

Thank You lawguil! I am from the day when we wore white, caps, white hose, white shoes. While I don't want to go back to those days, scrubs are comfy, being a good nurse is being a professional no matter what you're wearing and of course being a patient advocate is all important.

I do however applaud my employer who now requires a badge that hangs under our names that states RN. Now the patients know who the nurses are

 

[foreverLaur]

what's an example of a task that only nurses can do and doctors cannot?

Maybe more accurately... won't do. The nurses on the floor I worked on used to hate it when the docs rounded in the AM. They would be in a patient room and the IV pump would start beeping or the patient would ask for a blanket. The doctors would rather wait in the hall 5-6 minutes for someone to come by and ask him/her to get a blanket than to just go get the blanket themselves.

Most of the time with the IV pumps, it would just simply be that the line was occluded which 99% of the time just means the pump needs restarted because the patient had their IV in their AC and they moved weird. They docs would sit there and listen to that annoying thing beep til someone showed up - wouldn't even hit the call light. Can they not touch IV pumps or call lights or what's up?

 

[chimichanga]

... They would be in a patient room and the IV pump would start beeping or the patient would ask for a blanket. The doctors would rather wait in the hall 5-6 minutes for someone to come by and ask him/her to get a blanket than to just go get the blanket themselves.

... Can they not touch IV pumps or call lights or what's up?

Agree on the blanket thing...At least ask someone where the blankets are...

However, I'm not sure the IV pump is a fair thing...
The RN is responsible for that, and the docs likely aren't familiar with programming a pump, nor should they be...

 

[JeffLebowski]

Agree on the blanket thing...At least ask someone where the blankets are...

However, I'm not sure the IV pump is a fair thing...
The RN is responsible for that, and the docs likely aren't familiar with programming a pump, nor should they be...

For the record, just because one person says she sees doctors ignore patient requests that could be quickly and easily satisfied, many DO help out even though it isn't really their job, grab blankets, clean up patients, help with little stuff when they can. But give us the benefit of the doubt that we're not just jerks...sometimes we're on rounds and believe me you can't just break away from rounds to get a blanket, sometimes we're waiting for an important call, sometimes we're meeting an attending, sometimes we're just honestly too busy. And some of us have been yelled at by nurses for doing stuff like that (not joking this has happened more than once for pretty harmless stuff; although most of the time nurses are grateful and courteous) so you can see there's a lot of factors that tend to keep us from jumping on every grenade. But many of us do lots of things like that as much as we are able.

 

[foreverLaur]

Maybe it is just the ones that round on my floor. The problem is that the docs always round during shift change. I remember once I came back down the hall cuz I forgot my coat and I find a doc sittin there and he goes: "About time! I've been waiting 7 minutes for someone - I'm a busy man! The patient in 914 needs a blanket."

Someone should at least educate them on the call light 🙂

Then again I've encountered techs, nurses, etc who won't help out unless it is their patient and their direct responsibility. Some of the nurses I've worked with won't even fill up a patients water pitcher even though they're going to the same room. They will, however, put forth the extra effort to walk around and find me and tell me to do it. And I've encountered techs that won't help me pull up a patient or clean up a patient because "hey they aren't my problem tonight."

Sure makes you appreciate those that are willing to help out though.

 

[deleted6669]

you missed the periods.
many D.O. help out.......🙂

 

[chimichanga]

For the record, just because one person says she sees doctors ignore patient requests that could be quickly and easily satisfied, many DO help out even though it isn't really their job, grab blankets, clean up patients, help with little stuff when they can. But give us the benefit of the doubt that we're not just jerks...sometimes we're on rounds and believe me you can't just break away from rounds to get a blanket, sometimes we're waiting for an important call, sometimes we're meeting an attending, sometimes we're just honestly too busy. And some of us have been yelled at by nurses for doing stuff like that (not joking this has happened more than once for pretty harmless stuff; although most of the time nurses are grateful and courteous) so you can see there's a lot of factors that tend to keep us from jumping on every grenade. But many of us do lots of things like that as much as we are able.

points well taken. My experience has mostly been with attendings, who on rare occasion, seemingly go out of their way to NOT be helpful (mainly hospitalists and ER docs...)

However, I've emptied many a trash can myself...Last I checked, we have housekeeping for that, but I digress...

Nursing likely yelled at you getting a blanket for her patient with a fever...A lame, tired old wive's tale. I see it all the time...I tell them, next time YOU have a fever at home, lay in bed w/ no blanket...You'll freeze...Idiot nurses...

However, writing an order (more than one ER doc in my time) to "remove socks", then placing the chart in the order rack, and sitting down to dictate, makes you an absolute dick...I think that's the example that sums up Laura's sentiment...

 

[JeffLebowski]

Maybe it is just the ones that round on my floor. The problem is that the docs always round during shift change. I remember once I came back down the hall cuz I forgot my coat and I find a doc sittin there and he goes: "About time! I've been waiting 7 minutes for someone - I'm a busy man! The patient in 914 needs a blanket."

Someone should at least educate them on the call light 🙂

Then again I've encountered techs, nurses, etc who won't help out unless it is their patient and their direct responsibility. Some of the nurses I've worked with won't even fill up a patients water pitcher even though they're going to the same room. They will, however, put forth the extra effort to walk around and find me and tell me to do it. And I've encountered techs that won't help me pull up a patient or clean up a patient because "hey they aren't my problem tonight."

Sure makes you appreciate those that are willing to help out though.

Yeah, I agree. And some people are just dumb or jerks, no matter their job.

you missed the periods.
many D.O. help out.......🙂

Because D.O.'s are less busy? Less clinically experienced? Is that what you're saying? Let's do this.

points well taken. My experience has mostly been with attendings, who on rare occasion, seemingly go out of their way to NOT be helpful (mainly hospitalists and ER docs...)

However, I've emptied many a trash can myself...Last I checked, we have housekeeping for that, but I digress...

Nursing likely yelled at you getting a blanket for her patient with a fever...A lame, tired old wive's tale. I see it all the time...I tell them, next time YOU have a fever at home, lay in bed w/ no blanket...You'll freeze...Idiot nurses...

However, writing an order (more than one ER doc in my time) to "remove socks", then placing the chart in the order rack, and sitting down to dictate, makes you an absolute dick...I think that's the example that sums up Laura's sentiment...

Well yeah, we could each exchange stories about nurses vs. doctors being jerks to each other, but it's counterproductive. I think the bottom line is that some nurses are jerks, some doctors are jerks, we should each do our job without expecting others to do it for us, but offer help each other and our patients whenever we can. Otherwise this will just turn acrimonious.

 

[Paseo Del Norte]

However, writing an order (more than one ER doc in my time) to "remove socks", then placing the chart in the order rack, and sitting down to dictate, makes you an absolute dick...I think that's the example that sums up Laura's sentiment...

That order thing can work to your advantage. Check this out, crazy stuff. I was working an assignment at one of the best ER's I have ever worked in. I was assigned to triage and having a blast. Not really, I absolutely hate triage.

So, the ER gets a call from EMS that a homeless male was hit by a car. Staff calls me to help out when the patient rolls in. It was new grad night, but they were pretty good dudes and dudettes. EMS was not lying, the patient looked like he had been hit by a car. I set up for the RSI, our doc tubes the patient, and the staff volunteers me to take the guy to CT. Aside from some ortho trauma, guy has a big subdural, mass effect, midline shift, typical I was hit by a car stuff.

So, back in the ER ready to hand the patient off to another nurse so I can resume my triage post and the doc pulls me aside. Patient is pretty bad, four hour wait on medevac do to weather, asks me about how I worked as a flight nurse. I told him, generally two providers to a single patient. He give me a strange look than says "well you need to stay with the patient", then writes an order: "Paseo Del Norte, one on one care for patient XYZ until medevac." You can't make this stuff up. I was absolutely shocked, no way this is going to fly. Low and behold, I spent the next 4 hours sitting on my duff watching the ventilator cycle. Sure, I placed an NG tube and foley, kept the patient warm, gave sedation, analgesia, and paralytics, and called RT when the vent circuit plugged up (Strange HME failure). Shoot, most ICU nurses I know work harder than that with more patients.

So, the doc cut me a break that night. 😀

 

[zenman]

Agree on the blanket thing...At least ask someone where the blankets are...

However, I'm not sure the IV pump is a fair thing...
The RN is responsible for that, and the docs likely aren't familiar with programming a pump, nor should they be...

I worked with a physician a couple years ago who told me they were not trained to do a lot of "technical stuff" because nurses would always be around to do it. I found this out after she would ask me to get a BP, then would stand right next to me chatting to the patient. I'm thinking, "will you allow the patient to be quiet for a minute" or "if you're going to stand right here why don't you get the BP since I'm kinda busy?"

 

[DutchgirlRN]

Have you seen a doctor draw blood? Start an IV? Run a Code? Clean up poop? Empty a catheter? Hang an IV bag? Silence a pump? Answer a call light? I'm not saying they couldn't do it, well not well anyway.

I can't do what doctors can do. I think we've got a good system going 🙂

 

[chimichanga]

Have you seen a doctor draw blood? Start an IV? Run a Code? Clean up poop? Empty a catheter? Hang an IV bag? Silence a pump? Answer a call light? I'm not saying they couldn't do it, well not well anyway.

I can't do what doctors can do. I think we've got a good system going 🙂

uh, ED docs run codes quite well...

 

[J1515]

Have you seen a doctor draw blood? Start an IV? Run a Code? Clean up poop? Empty a catheter? Hang an IV bag? Silence a pump? Answer a call light? I'm not saying they couldn't do it, well not well anyway.

Doctors always run codes. In every hospital I've been at it was always either the senior IM or surgery resident, or physician. I've never seen a nurse run a code (and rightfully so). What I have seen at a certain hospital is all the nurses on the floor scrambling around the coding patient's room and chaotically shouting orders at each other, yelling at the medical students to get out, until the resident or physician comes in and takes control. The one thing nurses always loved to do is yell at the med students to get out of the room (powertrip...the only way for us to learn was to watch and experience it). I always ignored them - the resident running the code would laugh and then tell me to jump in and start doing compressions.

As far as starting IVs, doctors get asked to start IVs all the time. It's usually as a last resort when the nurse, intern, and residents can't get it. It never really made sense to me, seeing as nurses and interns have the most practice, but magically the docs would get it sometimes.

 

[zenman]

Doctors always run codes. In every hospital I've been at it was always either the senior IM or surgery resident, or physician. I've never seen a nurse run a code (and rightfully so).

I've run codes both inhouse and pre-hospital, but was always glad to turn it over to the most senior person. I always thought it was funny to see a resident pull out their ACLS book and read from it...guess you get it right that way!

Interesting story. We had a code once in a semi-private room. The guy didn't make it and while his family was still standing around his body, the other guy coded and didn't make it. Really strange night, especially for the nurse who had both guys.

 

[deleted6669]

Because D.O.'s are less busy? Less clinically experienced? Is that what you're saying? Let's do this.
.

NOPE, NONE OF THE ABOVE.
most of the D.O.'s I have worked with over the years are just more laid back and less uptight than their md counterparts and more likely to help out their colleagues(which includes non-docs...). this is a good thing. it's likely because of the differences in the applicant pool:
md: young gunners. all about the gpa/mcat/research.
D.O.: typically older applicants, often with more life experience or prior careers, emphasis on factors other than gpa/mcat/research.

yes, there are mellow md's and uptight do's but on avg the above sterotypes have been true in my experience working in medicine for 23 years

 

[tncekm]

Have you seen a doctor draw blood? Start an IV? Run a Code? Clean up poop? Empty a catheter? Hang an IV bag? Silence a pump? Answer a call light? I'm not saying they couldn't do it, well not well anyway.

I can't do what doctors can do. I think we've got a good system going 🙂

They're busy practicing medicine while nurses practice nursing. Of course they're not going to pick up poop and empty a catheter. That'd be a colossal waste of resources.

 

[J1515]

I always thought it was funny to see a resident pull out their ACLS book and read from it...guess you get it right that way!

Never seen it happen. The ACLS protocol is on step 2, step 3, the inservice exams, and the specialty boards. We know it like the back of our hands. Outside of a few poor programs, that's one thing residents know well from intern year.

 

[chimichanga]

always the same pisssing contest...

so tired...

speaking of...where is he?

i miss the love

 

[DutchgirlRN]

Of course ER docs run codes and do it very well. In the hospital where I work we don't have med students, residents, interns, etc....just your average PCP's or hospitalists. Guess I should have considered the big hospital setting before posting about docs running codes. Where I work it is the nurses who run the codes (and do it well) unless one of the cardiologists happens to grace us with their presence. The ER doctor will arrive with a code in progress and take over. My apologies.

 

[psychbender]

Never seen it happen. The ACLS protocol is on step 2, step 3, the inservice exams, and the specialty boards. We know it like the back of our hands. Outside of a few poor programs, that's one thing residents know well from intern year.

I've seen it happen a bunch. It used to annoy the crap out of me when I was a med student, as I also worked as a medic and ran scores more codes than those residents had even seen. This wasn't all at the same program/hospital, either, and during my last ACLS class, I was chided by one of the instructors for not reading from the book during one of the practice codes.

I also like walking into a room when no one can get a line/draw blood, and getting something on the first stick. Its funny (in a totally I'm-a-jack-ass way) when everyone expects you to be a know-nothing intern, and you prove more adept at a particular technical skill than they are. Who knew doctors may have had a life in healthcare before medical school? Once I started doing this, I got fewer idiotic 3am pages from the floor nurses asking for tylenol for temps of 99.4, but would occasionally get called to start an IV/draw blood on patients that were not even mine.

 

[J1515]

I've seen it happen a bunch. It used to annoy the crap out of me when I was a med student, as I also worked as a medic and ran scores more codes than those residents had even seen. This wasn't all at the same program/hospital, either, and during my last ACLS class, I was chided by one of the instructors for not reading from the book during one of the practice codes.

During the actual ACLS class it doesn't matter whether you read from a book, stand on your head, or eat a burger. During a real code, residents should not be reading from a book and I have never seen this happen. In a hospital setting with a residency, a rapid response or code ____ is called and the residents run the code. I suppose if it's a smaller hospital or acute care facility with no residents or physicians around, someone else would be responsible for running it.

 

[fab4fan]

Agree on the blanket thing...At least ask someone where the blankets are...

However, I'm not sure the IV pump is a fair thing...
The RN is responsible for that, and the docs likely aren't familiar with programming a pump, nor should they be...

I agree. Sometimes hitting "Stop/Start" isn't the answer.

 

[fab4fan]

always the same pisssing contest...

so tired...

speaking of...where is he?

i miss the love

I was thinking the same thing.

 

[core0]

I was thinking the same thing.

Residency has a way of interfering with SDN. Speaking of pumps are you saying just randomly mashing buttons until it stops beating is not the way to "fix" them😉

 

[JeffLebowski]

NOPE, NONE OF THE ABOVE.
most of the D.O.'s I have worked with over the years are just more laid back and less uptight than their md counterparts and more likely to help out their colleagues(which includes non-docs...). this is a good thing. it's likely because of the differences in the applicant pool:
md: young gunners. all about the gpa/mcat/research.
D.O.: typically older applicants, often with more life experience or prior careers, emphasis on factors other than gpa/mcat/research.

yes, there are mellow md's and uptight do's but on avg the above sterotypes have been true in my experience working in medicine for 23 years

Well, I was jokingly engaging you in an MD vs. DO debate since you drew first blood, but instead of perpetuating it I'll just say that I'm offended by your assertions and supposed "insight" that how budding MDs are "young gunners. all about the gpa/mcat/research".

 

[fab4fan]

Residency has a way of interfering with SDN. Speaking of pumps are you saying just randomly mashing buttons until it stops beating is not the way to "fix" them😉

Exactly. There's a reason the pump is reading "Distal Occlusion." Silencing the alarm won't get you brownie points when the pt needs to have the IV restarted.

 

[San_Juan_Sun]

All I know about IV pumps is that pushing "Silence" buys you two minutes of quiet, usually enough to get out of the room. 🙂

 

[deleted6669]

All I know about IV pumps is that pushing "Silence" buys you two minutes of quiet, usually enough to get out of the room. 🙂

just like achmed the dead terrorist:
"SILENCE....I kill you....." 🙂

I hate pumps as well and never use them when I mix my own drips. I learned this stuff in the pre-pump era as a medic and guess what? it still works.

 

[zenman]

Never seen it happen. The ACLS protocol is on step 2, step 3, the inservice exams, and the specialty boards. We know it like the back of our hands. Outside of a few poor programs, that's one thing residents know well from intern year.

I've only seen one resident do it in an ICU in Hawaii. It has really aggravated some people when I explained that Hawaii was a great intro or stepping stone for when I went to a third world country.

 

[zenman]

always the same pisssing contest...

so tired...

speaking of...where is he?

i miss the love

Oh relax. When someone has a habit of saying, "Doctors always run codes" or "I've never seen it happen" some of us are just saying that it can and does happen...in our experience. That's all, period. The only pissing contest we'd have would be over a few beers.

 

[zenman]

just like achmed the dead terrorist:
"SILENCE....I kill you....." 🙂

I hate pumps as well and never use them when I mix my own drips. I learned this stuff in the pre-pump era as a medic and guess what? it still works.

I agree. I always enjoyed the quiet few minutes figuring out a drip rate and counting the falling drops. But I think now most places have them now as a matter of policy.

 

[SOLDIER]

haha i am a Mb Bch 😕

 

[Paseo Del Norte]

haha i am a Mb Bch 😕

That's South African for physician, I consider it the same as MD/DO.

It's all lekker me bro. 😀

 

[SOLDIER]

That's South African for physician, I consider it the same as MD/DO.

It's all lekker me bro. 😀

haha dankie dankie bro

 

[Paseo Del Norte]

No worries mate, you are welcome.

 

[SOLDIER]

No worries mate, you are welcome.

are u from here ?

 

[Paseo Del Norte]

No, I worked in Afghanistan as a contractor with a company run by South Africans. Worked closley with several South African doctors and medics. (mostly B-Techs) I learned enough Afrikaans to sound like an idiot, much to the pleasure of my colleagues.

The funnest thing to do was yell out in a large group: "Ou Khriez what's it all about me bro?" I would yell back, "it's all about the blare." (Not sure of the spelling, but a slang for money.) I was known as the imitation South African.

 

[deleted6669]

I agree. I always enjoyed the quiet few minutes figuring out a drip rate and counting the falling drops. But I think now most places have them now as a matter of policy.

HMMM,wonder who wrote those policies.....?

 

[SOLDIER]

Dp

 

[SOLDIER]

No, I worked in Afghanistan as a contractor with a company run by South Africans. Worked closley with several South African doctors and medics. (mostly B-Techs) I learned enough Afrikaans to sound like an idiot, much to the pleasure of my colleagues.

The funnest thing to do was yell out in a large group: "Ou Khriez what's it all about me bro?" I would yell back, "it's all about the blare." (Not sure of the spelling, but a slang for money.) I was known as the imitation South African.

Haha yes u spell it correct haha blare means leaves
We have nick names for every one and we say OU in front if we yell the name

U must come to south africa we can have a braai and have a few drinks

 

[Paseo Del Norte]

Thanks mate. I actually want to go to South Africa. I am in school for the next couple of years, and it's a programme where we go through the summers, so no real break save for some time over Christmas.

I have friends in the Johannesburg, Cape Town, and Pretoria. I will shoot you a PM when the wife and I plan on doing the trip. Perhaps a graduation trip will be in order?

A braai sounds great. We had some great braai's in Afghanistan. Damn South African's had connection all over the place and would wheel and deal all day long. Always had a fresh supply of alcohol, pity as I do not drink; however, it was fun to go on recon and "drug deal" missions to obtain alcohol for our monthly braai. We even had a small meat grinder and spices from the mother land, and I was educated in the sacred art of making boerewors.

 

[SOLDIER]

Thanks mate. I actually want to go to South Africa. I am in school for the next couple of years, and it's a programme where we go through the summers, so no real break save for some time over Christmas.

I have friends in the Johannesburg, Cape Town, and Pretoria. I will shoot you a PM when the wife and I plan on doing the trip. Perhaps a graduation trip will be in order?

A braai sounds great. We had some great braai's in Afghanistan. Damn South African's had connection all over the place and would wheel and deal all day long. Always had a fresh supply of alcohol, pity as I do not drink; however, it was fun to go on recon and "drug deal" missions to obtain alcohol for our monthly braai. We even had a small meat grinder and spices from the mother land, and I was educated in the sacred art of making boerewors.

Haha a braai isn't a braai with out beer brandy and boere wors
Its a way of life there is no way around it
But u must know u always welocom here in south africa this place is not that bad lol

 

[DutchgirlRN]

I hate pumps as well and never use them when I mix my own drips. I learned this stuff in the pre-pump era as a medic and guess what? it still works.

I freaking love IV pumps. I worked in the days when there was no such thing as an IV pump. I can remember having a little CHF'er with dementia who liked to play with her roller clamp and she managed to infuse 1000cc within 30 minutes 😱 Far as I can remember no real harm was done but hey.

Now our pumps have locks on them because patients have figured out how to reset them. You give them IV pain meds and then they would bolus themselves. PCA's are awesome. Makes the nurses job alot easier and safer for the patient.

 

[deleted6669]

ok, I can see the advantage for a pca pump.
if someone needs 1 l ns wide open they don't need a pump as it will just slow down the infusion.
most of the infusions I order commonly can be run without a pump if someone does a bit of basic math. I work solo in a small dept on night shifts very frequently with just 1 tech and 1 nurse.
I start a lot of my own IV's, push a lot of meds, and often mix my own drips. I never use a pump, even for dopamine.

 

[zenman]

I start a lot of my own IV's, push a lot of meds, and often mix my own drips. I never use a pump, even for dopamine.

What about Propofol 🙂. You didn't treat uh, what's his name...Michael Jackson did you?

 

[deleted6669]

What about Propofol 🙂. You didn't treat uh, what's his name...Michael Jackson did you?

I use propofol by titrated IV push, not by infusion....
and i'm sure that other guy had michael sign an informed consent at bedtime every night and he must have had an entire procedural sedation team present the entire night per joint commission requirements, right?

 

[DutchgirlRN]

ok, I can see the advantage for a pca pump.
if someone needs 1 l ns wide open they don't need a pump as it will just slow down the infusion.
most of the infusions I order commonly can be run without a pump if someone does a bit of basic math. I work solo in a small dept on night shifts very frequently with just 1 tech and 1 nurse.
I start a lot of my own IV's, push a lot of meds, and often mix my own drips. I never use a pump, even for dopamine.

You can bolus a patient by setting the pump at 999ml/hr and that usually runs it in faster than wide open, unless you have an IV in that is at least a 18g. Personally I use 20g on most every patient. I understand that you can run dopamine off of a pump but why? Patients and patients families have a bad habit of playing with roller clamps. I wouldn't want that responsibility. You can't sit in the room with the patient for 12 hours. We require per protocol dopamine, lasix, and other such meds to be on a pump.

 

[Paseo Del Norte]

I start a lot of my own IV's, push a lot of meds, and often mix my own drips. I never use a pump, even for dopamine.

Ummm, ok then. Regarding propofol: You mean to say that people in your ER are simply given IV push propofol for ongoing sedation? You would essentially need a one on one provider to push propofol. I could not see a patient going to ICU with propofol IVP PRN orders. 😱