HI, got a question here..........which are the fields in medicine can a Nurse practitioner specialize and practice in?
Thanks
Nev
Thanks
Nev
nurse practitioner fields
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The real question is "what fields can a nurse practitioner work in or bill 'incident to' a physician". A physician hires generally based upon the midlevel provider's experience. So if they are "certified" in peds, a pediatrician may be interested in hiring the midlevel etc etc.
But there are no true residencies in the "medicine" sense of the word that will "train" the midlevel formally. Primarily it is "on the job".
But there are no true residencies in the "medicine" sense of the word that will "train" the midlevel formally. Primarily it is "on the job".
D
deleted6669
"But there are no true residencies in the "medicine" sense of the word that will "train" the midlevel formally. Primarily it is "on the job"."
for a full description of these "nonexistent" accredited residencies for pa's in er, ortho, gen. surg., ct surgery, ob, psych, peds, derm, hospitalist medicine, rural medicine, fp, urology, neurology,and oncology
see www.appap.org
oh look here's the info on the non-existent surgical residency at duke:
PA Surgical Residency
Program Director: Paul C. Hendrix, MHS, PA-C
Duke University Medical Center
Box 3704
Durham, North Carolina 27710
Telephone: (919) 684-2705
Fax: (919) 681-2779
E-mail: [email protected]
--------------------------------------------------------------------------------
Length of Program 12 months
Class Size 15
Starting Date: September 1
Ending Date: August 31
PROGRAM DESCRIPTION AND HISTORY:
The PA Profession originated at Duke in the mid 1960s. Dr. Eugene A. Stead, Jr., then Chairman of the Department of Medicine, believed that mid-level practitioners could increase consumer access to health services by extending the time and skills of the physician. His vision, guidance, and influence were instrumental in founding the Duke PA Program, which continues to flourish as one of the premier PA training programs in the country. We plan to follow in this rich tradition of excellence with the Duke PA Surgical Residency Program.
The Duke Physician Assistant Surgical Residency is an intensive 12-month program administered by the Department of Surgery at Duke University Medical Center. PA Residents will be members of the surgical team and will be involved in pre-operative, intra-operative, and post-operative patient care. The residency is designed to provide both advanced didactic education and a focused, surgical clinical experience so that trainees and graduates will have the skills to provide high quality perioperative patient care. The residency is attractive both for new PA Program graduates who are planning a surgical career and for practicing physician assistants who wish to redirect their careers toward one of the surgical specialties or enhance their knowledge and skills through post-graduate education.
CURRICULUM:
Didactic
Lectures, seminars and laboratories have been designed to provide PA Residents with a comprehensive understanding of the pathophysiology of surgical disease processes. Instruction will cover general surgery and subspecialty topics. Emphasis will be placed on the perioperative management of surgical patients including fluids and electrolytes, hyperalimentation, acid/base balance, surgical emergencies, complications, and evaluation of specific organ systems. Cadaver laboatories will include technical skills instruction and practice time for wound closure, chest tube placement, thoracentesis, endoscopic vein harvesting, placement of peripheral lines, etc. In addition to classroom/laboratory instruction, the didactic curriculum will include weekly Attending Rounds, Grand Rounds, M&M Conference and other conferences organized by the Department of Surgery. The initial didactic curriculum will conclude with preparation for clinical rotations. Time is designated for "rounding" with the surgical team and becoming familiar with the routine of the surgical services before assuming clinical responsibilities
Clinical
Physician Assistant Residents will be assigned a workload and duties similar to those of first year (PGY1) physician surgical residents. Duties will include history & physical examinations, writing patient orders and progress notes in the hospital record, responding to and evaluating patient problems, making rounds, ordering diagnostic studies, assisting in the operating room, and performing invasive procedures with appropriate oversight by the supervising physician. Night call will be assigned on a rotating basis. The PA resident will be assigned first-call responsibilities with appropriate supervision and within the scope of his/her practice parameters. The PA Resident will avail himself/herself of additional direction and/or assistance as needed. As required by state law, all clinical activities of the PA Resident will be supervised by the PA Resident's supervising physician.
Clinical rotations make up eleven months of the curriculum. Core rotations include 5-6 months on the General Surgery services including Vascular, GI, Colorectal, Surgical Oncology, Trauma, and Transplant; one month on Cardiothoracic, one month at Durham Regional Hospital, one month at the Ambulatory Surgical Center, and two months of electives. Electives can be chosen from a wide range of subspecialties including Plastics, ENT, SICU, Neurosurgery, Orthopaedics, Urology, Pediatric Surgery, and others.
UNIVERSITY/INSTITUTION AFFILIATIONS:
Duke University Medical Center is an integral part of Duke University. Duke Hospital, a private nonprofit institution and one of the largest private hospitals in the south, is part of the Medical Center and currently has 1,124 beds. The hospital directs its efforts toward the goals of cutting edge patient care, professional education, and service to the community.
More than 36,000 patients are admitted annually. Surgical facilities include thirty-two operating rooms in which more than 20,000 operative procedures are performed each year. Ambulatory services, including outpatient clinics and the emergency department, register more than 548,000 patient visits each year.
Duke Hospital is fully approved by the Accreditation Council for Graduate Medical Education for internship and residency training and by the Joint Commission on Accreditation of Health Care Organizations. The Medical Center, its schools, and hospital are located on the West Campus of Duke University.
ADMISSION REQUIREMENTS:
Graduation from a PA Training Program approved by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA).
Bachelor's degree
Must have passed or be eligible to take the National Commission on Certification of Physician Assistants (NCCPA) Certification Examination.
Official transcripts from colleges and PA school
Copies of BLS and ACLS certification cards
One page typewritten narrative stating why you are interested in postgraduate surgical training
Three letters of recommendation
Official NCCPA Exam scores (if certified)
Signed copy of the 'Authorization Agreement'
Current resume
$25 application fee
TIMELINE:
November 1 Program application form available
March 15 Applications must be postmarked
Early May Interviews
September 1 Program starting date
CREDENTIAL AWARDED:
Certificate of completion will be awarded from Duke University Medical Center and the Department of Surgery
FINANCIAL INFORMATION:
Stipend - $39,960 (2004)
Professional liability insurance
$75,000 group term life insurance
Uniforms
Exercise facility
Meals when on-call in the hospital
Parking provided in adjacent parking garage
15 days paid vacation accruing over time
Medical and Dental Insurance
Life insurance
Disability insurance
Prescription drug program
Health Care reimbursement account
Retirement program
INFORMATION:
Detailed information about our Program and all materials necessary for application can be found on our web site:
http://surgery.duke.edu/PAresidency
For further information contact the admissions office:
Telephone: (919) 684-2705
Fax: (919) 681-2779
E-mail: [email protected]
for a full description of these "nonexistent" accredited residencies for pa's in er, ortho, gen. surg., ct surgery, ob, psych, peds, derm, hospitalist medicine, rural medicine, fp, urology, neurology,and oncology
see www.appap.org
oh look here's the info on the non-existent surgical residency at duke:
PA Surgical Residency
Program Director: Paul C. Hendrix, MHS, PA-C
Duke University Medical Center
Box 3704
Durham, North Carolina 27710
Telephone: (919) 684-2705
Fax: (919) 681-2779
E-mail: [email protected]
--------------------------------------------------------------------------------
Length of Program 12 months
Class Size 15
Starting Date: September 1
Ending Date: August 31
PROGRAM DESCRIPTION AND HISTORY:
The PA Profession originated at Duke in the mid 1960s. Dr. Eugene A. Stead, Jr., then Chairman of the Department of Medicine, believed that mid-level practitioners could increase consumer access to health services by extending the time and skills of the physician. His vision, guidance, and influence were instrumental in founding the Duke PA Program, which continues to flourish as one of the premier PA training programs in the country. We plan to follow in this rich tradition of excellence with the Duke PA Surgical Residency Program.
The Duke Physician Assistant Surgical Residency is an intensive 12-month program administered by the Department of Surgery at Duke University Medical Center. PA Residents will be members of the surgical team and will be involved in pre-operative, intra-operative, and post-operative patient care. The residency is designed to provide both advanced didactic education and a focused, surgical clinical experience so that trainees and graduates will have the skills to provide high quality perioperative patient care. The residency is attractive both for new PA Program graduates who are planning a surgical career and for practicing physician assistants who wish to redirect their careers toward one of the surgical specialties or enhance their knowledge and skills through post-graduate education.
CURRICULUM:
Didactic
Lectures, seminars and laboratories have been designed to provide PA Residents with a comprehensive understanding of the pathophysiology of surgical disease processes. Instruction will cover general surgery and subspecialty topics. Emphasis will be placed on the perioperative management of surgical patients including fluids and electrolytes, hyperalimentation, acid/base balance, surgical emergencies, complications, and evaluation of specific organ systems. Cadaver laboatories will include technical skills instruction and practice time for wound closure, chest tube placement, thoracentesis, endoscopic vein harvesting, placement of peripheral lines, etc. In addition to classroom/laboratory instruction, the didactic curriculum will include weekly Attending Rounds, Grand Rounds, M&M Conference and other conferences organized by the Department of Surgery. The initial didactic curriculum will conclude with preparation for clinical rotations. Time is designated for "rounding" with the surgical team and becoming familiar with the routine of the surgical services before assuming clinical responsibilities
Clinical
Physician Assistant Residents will be assigned a workload and duties similar to those of first year (PGY1) physician surgical residents. Duties will include history & physical examinations, writing patient orders and progress notes in the hospital record, responding to and evaluating patient problems, making rounds, ordering diagnostic studies, assisting in the operating room, and performing invasive procedures with appropriate oversight by the supervising physician. Night call will be assigned on a rotating basis. The PA resident will be assigned first-call responsibilities with appropriate supervision and within the scope of his/her practice parameters. The PA Resident will avail himself/herself of additional direction and/or assistance as needed. As required by state law, all clinical activities of the PA Resident will be supervised by the PA Resident's supervising physician.
Clinical rotations make up eleven months of the curriculum. Core rotations include 5-6 months on the General Surgery services including Vascular, GI, Colorectal, Surgical Oncology, Trauma, and Transplant; one month on Cardiothoracic, one month at Durham Regional Hospital, one month at the Ambulatory Surgical Center, and two months of electives. Electives can be chosen from a wide range of subspecialties including Plastics, ENT, SICU, Neurosurgery, Orthopaedics, Urology, Pediatric Surgery, and others.
UNIVERSITY/INSTITUTION AFFILIATIONS:
Duke University Medical Center is an integral part of Duke University. Duke Hospital, a private nonprofit institution and one of the largest private hospitals in the south, is part of the Medical Center and currently has 1,124 beds. The hospital directs its efforts toward the goals of cutting edge patient care, professional education, and service to the community.
More than 36,000 patients are admitted annually. Surgical facilities include thirty-two operating rooms in which more than 20,000 operative procedures are performed each year. Ambulatory services, including outpatient clinics and the emergency department, register more than 548,000 patient visits each year.
Duke Hospital is fully approved by the Accreditation Council for Graduate Medical Education for internship and residency training and by the Joint Commission on Accreditation of Health Care Organizations. The Medical Center, its schools, and hospital are located on the West Campus of Duke University.
ADMISSION REQUIREMENTS:
Graduation from a PA Training Program approved by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA).
Bachelor's degree
Must have passed or be eligible to take the National Commission on Certification of Physician Assistants (NCCPA) Certification Examination.
Official transcripts from colleges and PA school
Copies of BLS and ACLS certification cards
One page typewritten narrative stating why you are interested in postgraduate surgical training
Three letters of recommendation
Official NCCPA Exam scores (if certified)
Signed copy of the 'Authorization Agreement'
Current resume
$25 application fee
TIMELINE:
November 1 Program application form available
March 15 Applications must be postmarked
Early May Interviews
September 1 Program starting date
CREDENTIAL AWARDED:
Certificate of completion will be awarded from Duke University Medical Center and the Department of Surgery
FINANCIAL INFORMATION:
Stipend - $39,960 (2004)
Professional liability insurance
$75,000 group term life insurance
Uniforms
Exercise facility
Meals when on-call in the hospital
Parking provided in adjacent parking garage
15 days paid vacation accruing over time
Medical and Dental Insurance
Life insurance
Disability insurance
Prescription drug program
Health Care reimbursement account
Retirement program
INFORMATION:
Detailed information about our Program and all materials necessary for application can be found on our web site:
http://surgery.duke.edu/PAresidency
For further information contact the admissions office:
Telephone: (919) 684-2705
Fax: (919) 681-2779
E-mail: [email protected]
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John Hopkins Post-Graduate Surgical Residency for Physician Assistants
My friend is in her "non-existent" surgical resideny at John Hopkins & she's working her a** off!
Good luck Nev....you might want to consider the Physician Assistant profession if the NP world does not have an area of specialty interest for you.
Do your research & good luck!
M
My friend is in her "non-existent" surgical resideny at John Hopkins & she's working her a** off!
Good luck Nev....you might want to consider the Physician Assistant profession if the NP world does not have an area of specialty interest for you.
Do your research & good luck!
M
5
50960
This forum is mainly PA focused, so you should probably go to your state or national NP organization to get the real info. It does not seem as though your question was properly answered.
D
deleted6669
np programs are specific to a given field. some programs exist in the following. there may be others:
family
adult
peds
ob
psych
critical care/acute care
keep in mind that fnp is the most flexible. any of the others require additional training to switch fields. a peds np can't see adults or ob for instance.
family
adult
peds
ob
psych
critical care/acute care
keep in mind that fnp is the most flexible. any of the others require additional training to switch fields. a peds np can't see adults or ob for instance.
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psisci said:This forum is mainly PA focused, so you should probably go to your state or national NP organization to get the real info. It does not seem as though your question was properly answered.
Psisci is right about this forum so try www.allnurses.com and go to their nurse practitioner forum. Read a lot of posts and you will get an idea.
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RNnowDoclater said:
Actually Nev, EmedPA is wonderful resource on this forum. He presents a lot of objective information about both professions and is able put things in perspective for aspiring midlevel students. As part of my job at an academic institution advising these types of students, I often have to do my research about these professions to properly advise them. Sorry RNnowDoclater and Psisci, but if you are interested in a midlevel career, you have far MORE opportunity as a PA with respect training, what you want to practice (specialty), and changing specialties. If you don't believe what EmedPA is saying, do your research by going to a states professional regulatory board, schools offering the degrees, and each professions individual organization. Obviously each one will be trying to sell the degree, but if you have specific questions about each one (coursework, clinical rotations and hours, autonomy, practice acts ect.) you can compare the two side by side and see for yourself. Sending somebody to a forum saturated with NP's if not going to give Nev the objective data you seem to think she deserves.
The fact is that as an advisor to student whom I am looking out for there best interests, I rarely encourage them to pursue NP training. If a nurse is looking for a midlevel career, I always give them the data, and point out the facts. I don't have to give them subjective opinions to influence there decision. On occasion though, when a student has children or financial burden that don't allow them to attend a full-time program, NP training becomes the supplement for PA training to achieve there career goals. Further, if a student is weaker academically and lacks hardcore science courses, NP training becomes the only option.
It might be behoove of some of us to understand the facts ourselves before we go passing off this forum and individual posters as "PA focused" and uninformative to a prospective student.
L.
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lawguil said:
Lawguil,
I do not think my short initial post above warranted your borderline hostile reply. The sentence you stated above in italics reveals that you are a biased advisor.
I am from a nursing background and NP is where I wish to spend my energies. My best friend is in a PA program and I think it's awesome for him. I am not wrong that this forum has a large PA focus. It is www.studentdoctor.com after all; PAs are of the medical model as you know. Www.allnurses.com has a lot of NP info as it is a nursing site.
You seem passionate about the PA pathway which is great. However, your implicit dislike towards the NP route is troublesome.
Remember, healthcare means TEAMwork!
Zman
My main goal is to be a PA. So, this is the blue print I have in mind:
I could probably complete a BSN degree and then apply to the PA program. However,there are only 16 and 18 hours of course work during the Junior and Senior years in BSN school. SO do you guys think that it would be a smart thing to complete organic chemistry and genetics while I am doing my BSN?
Nev
I could probably complete a BSN degree and then apply to the PA program. However,there are only 16 and 18 hours of course work during the Junior and Senior years in BSN school. SO do you guys think that it would be a smart thing to complete organic chemistry and genetics while I am doing my BSN?
Nev
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nev said:
It's possible, but if you ask most folks that have finished a nursing program, they are going to tell you "NO WAY".
Many people find nursing school tough. You will be packed up with a great deal of course work and clinical hours. Many nursing students often describe nursing school profs as "difficult".
That (along with block scheduling) may make it tough to do other classes outside of the nursing program.
Of course, since you are going to go to PA school and are going to have to take classes with the med students, it would probably be good practice!
With that said, you might be able to do it. I know 2 folks that took science classes (at night) while taking a full load of nursing classes. One lost all her hair. They both had no outside responsibilities (i.e., work). They did very well.
If you have a degree already, do one of the accelerated nursing programs. Some are as short as 12-16 months. You'll get 2-4 weeks off and a BSN at completion.
Why not try to take O-chem and genetics before you start the nursing program? With no distractions you can maximize your chances for an A. Unless you have them all done, you are still going to have to take prereq's before you apply for a nursing program. Why not take genetics and o-chem while you are doing your prereq's?
One more thing, nursing has become an very popular major in the last few years. You will find that many nursing programs are tough to get into because of the shear number of people applying. Some states have gone to a lottery system, many have waitlists. If you have good grades, apply early and are flexible with your choice of program, you will get in.
You might want to try posting this question on www.allnurses.com If you have a BSN program picked out you may get post from students in that program. Why not get the info from the horses mouth?
Good fortune and Good luck with you career choice.
Agape
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RNnowDoclater said:
Point well taken! Your right I do have a bias and it does show, however, I have based my opinion on objective measures. I really don't have a problem with NP's, but like most things, there is a hard way to reach your goal and an easy way. The PA path is the harder way. I encourage students to pay the price now if they can afford it! Some people might consider it good and caring advising for students. Sorry if I seem hostile because I do have a way of overstating my point. Best wishes with your NP training. I'm sure it's the BEST option for you. L.
5
50960
Lawquil, you may or may not be right about PA vs. NP, but either way I do not really care and more importantly that was not nev's question. Ignorance is not my problem, and I was just trying to help nev get the answer the question posted. Being as it was a question regarding NP specialties I thought a nursing site would be a good way to go..duh. Thou protesteth too much....
5
50960
There is a psychiatric NP residency at Napa State Hospital.
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To the person who was thinking it would be easy to take O Chem while in nursing school you may want to take the suggestion of taking it before your in the program. I am a senior nursing student and I was unable to take any classes outside of my nursing classes. In nursing school the "normal" 16-18 credits doesn't apply, you will be doing more work than that. Here's a partial list of my schedule:
Mon 7:45 am to 6:00 pm I have class with literally a one hour break for lunch
Tuesday I work monday nights so I sleep during the morning and then try to do homework and have to volunteer for nursing school in the afternoon
Wednesday 7:45 am to 2:00 pm class
Thursday full eight hour shift for clinical
Friday Full eight hour shift for clinical (these also can vary what shift you work ie day vs. pm vs. night shift)
On top of this I have approximently 15 hours of homework to do each week and I need to work so I work the night shift two nights a week. I don't mean to be complaining because I love it but taking those classes during the summer or before your program will allow you to spend the most time on that hard subject matter. All programs are different but you will be extremely busy in nursing school. Well good luck to you and I hope you do well in the career you choose!
p.s. Also nursing school is hard to get in to. At my school 700 people applied for 200 spots.
Mon 7:45 am to 6:00 pm I have class with literally a one hour break for lunch
Tuesday I work monday nights so I sleep during the morning and then try to do homework and have to volunteer for nursing school in the afternoon
Wednesday 7:45 am to 2:00 pm class
Thursday full eight hour shift for clinical
Friday Full eight hour shift for clinical (these also can vary what shift you work ie day vs. pm vs. night shift)
On top of this I have approximently 15 hours of homework to do each week and I need to work so I work the night shift two nights a week. I don't mean to be complaining because I love it but taking those classes during the summer or before your program will allow you to spend the most time on that hard subject matter. All programs are different but you will be extremely busy in nursing school. Well good luck to you and I hope you do well in the career you choose!
p.s. Also nursing school is hard to get in to. At my school 700 people applied for 200 spots.
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sunnkist said:
Great. That will get you prepared for PA school, where it is 700 applicants for 20-30 spots
Also, I worked full-time second shift as an ER tech during a full-time BSN program, so extra things can be done. It depends on the individual and program.
Pat
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"Resident: a graduate and licensed physician rcieving training in a specialty in a hospital" Dorland's Med. Dict.
NPs are not doctors, and hence can't receive "post-doctoral" training which is what a residency is so defined. Any further training is "apprenticeship".
Why do we, as a community, tolerate those with less training than an FP, become a "specialist"?
NP and PA fields were founded to meet the shortage of primary care providers. There are many specialties in primary care that an NP could have an interest in (gyn, fp, peds for example), but should we let non-physicians specialize in cardiology, or surgery which generally require a residency PLUS A FELLOWSHIP???
This is a dangerous slope. If you want to become a cardiologist, get your MD, do residency and fellowship . . .
if you want to become an NP, then do so and be happy, don't "play doctor" all your life.
LCR
NPs are not doctors, and hence can't receive "post-doctoral" training which is what a residency is so defined. Any further training is "apprenticeship".
Why do we, as a community, tolerate those with less training than an FP, become a "specialist"?
NP and PA fields were founded to meet the shortage of primary care providers. There are many specialties in primary care that an NP could have an interest in (gyn, fp, peds for example), but should we let non-physicians specialize in cardiology, or surgery which generally require a residency PLUS A FELLOWSHIP???
This is a dangerous slope. If you want to become a cardiologist, get your MD, do residency and fellowship . . .
if you want to become an NP, then do so and be happy, don't "play doctor" all your life.
LCR
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What your are saying is correct Ft.Dr. I have a classmate who was a NP "specializing" in cardiology. She claims that she was doing her own angiograms in Eastern Oregon, all she had to do was get a cardiologist to sign off on it. That is scary!!!!!!
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Docgeorge said:
Really? I wonder what the reiumbursment is for a nurse performing cardiac interventional procedures? Considering that it takes a physician 4 years of medical school, 3 years of internal medicine, 3 years of cardiology, and another 2-3 years for an interventional fellowship, it better be worth it.
I really, really should consolidate my loans so that I can go to nursing school.
Its not new for ARNPs to work w/cardiologists. There's one or two of them that virtually run the NON-invasive stress and echo labs at my hospital.
-PuSh
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When I say the cardilogist had to sign off on it the cardiologist is in Portland and she was some where off in eastern oregon without support.
On a different note, I have a Choric Care Pt who has CHF that I've had to follow since the middle of my 1st year. She see's her "NP" once a month and her Cardiologist once every 3-4 month. Imagine my suprrise when I actually met her that She is actually still finishing up her NP program at Creighton University on-line. I did'nt believe what I was hearing. I had to confirm what was said with my partner later.
You know what you're right let me know what you find out about the reinbursement rate, we can go to NP school together and you can get a cardiologist to sign you off to do angiograms and I'll get a CTS surgeon to sign me off on CABG. We can set up shop together.
On a different note, I have a Choric Care Pt who has CHF that I've had to follow since the middle of my 1st year. She see's her "NP" once a month and her Cardiologist once every 3-4 month. Imagine my suprrise when I actually met her that She is actually still finishing up her NP program at Creighton University on-line. I did'nt believe what I was hearing. I had to confirm what was said with my partner later.
You know what you're right let me know what you find out about the reinbursement rate, we can go to NP school together and you can get a cardiologist to sign you off to do angiograms and I'll get a CTS surgeon to sign me off on CABG. We can set up shop together.
I am trying to get into the BSN program. Will I have more releif if I do not work?
I need organic chem. and genetics to get into PA school, so I thought of taking organic in one year and then genetics in another year.
what do u guys think
Nev
I need organic chem. and genetics to get into PA school, so I thought of taking organic in one year and then genetics in another year.
what do u guys think
Nev
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Due to the cardiologist shortage ACC has suggested that under limited situations a midlevel can start a cath and squirt the dye. There is no way that they will ever be allowed to interpret, formulate a plan, or perform reperfusion interventions. I think that the whole thing will backfire anyway... I see a lot of patients in clinic who are P.O'd b/c they go to a cardiologist and see a PA or NP.
Now a CABG.... those are easy, of course they are being signed off
Now a CABG.... those are easy, of course they are being signed off
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windsurfr said:Due to the cardiologist shortage ACC has suggested that under limited situations a midlevel can start a cath and squirt the dye.
Now a CABG.... those are easy, of course they are being signed off
This is absolutely rediculous!!! Let's just get rid of doctors all together.
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windsurfr said:Now a CABG.... those are easy, of course they are being signed off
Appys maybe. I read the other day where the Navy medic who successfully perform an emergency appy (after having watched a couple) on board a sub during WWII died. His patient was back on duty in 13 days. Maybe mid-levels don't need as much training as we thought!
