Nurse propaganda

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SouthernSurgeon said:
Fun one we had recently:

pt goes to urgent care with chest pain and shortness of breath. NP diagnoses pneumonia clinically and sends out with oral antibiotics.

1 week later presents to ED with ventricular wall rupture as a complication of the MI he had been having a week ago when he saw the NP.

NP didn't get CXR, EKG, or labs.

Good times.
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I feel this was just an NP being lazy and not a reflection on education. Because back when I was working in a jail as a lowly LPN, and a chest pain inmate would come down, I knew to have the ekg machine ready and have the tubes I needed ready for stat labs.

I knew this as an LPN!! I know they learn to read ekgs but not cxr. That NP should lose her license.
 
Psai said:
Money is important but i think what gets nurses is the prestige, the white coat and the extra letters on their name. Also floor nursing sucks, you always have too many patients, too many tasks and too much bs charting
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Well floor nursing is horrendous, just do your year of med surg and bounce but the best nursing jobs are in home care/visting nursing...... Instantly you will make 10k more than a hospital which start at 65,000... put in a couple of more years they bump you up to 85,000.... then if you get more specialized you can salary at 95,000.. and work side jobs..... plus you do your own schedule you just have to see 52 people a month... so I see 15 people a week... 5 each monday, wednesday and friday home by 2:00PM everyday start at 10:30AM best job ever!
 
Psai said:
Money is important but i think what gets nurses is the prestige, the white coat and the extra letters on their name. Also floor nursing sucks, you always have too many patients, too many tasks and too much bs charting
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Yep, they want dat dere cake and eat it too. Everybody wants to be a doctor, but no one wants to go to school for 11 years.
 
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Hay @VisionaryTics

We had a patient right when I started working a few years ago who had been seeing some NP for pain because he had been "biting his tongue a lot" and "having difficulty swallowing" which she had treated with abx and peridex....

...I'm assuming she or he never bothered to look in the persons mouth, because I could see the massive lesion from like two feet away.

And he's now dead.
 
fancymylotus said:
Hay @VisionaryTics

We had a patient right when I started working a few years ago who had been seeing some NP for pain because he had been "biting his tongue a lot" and "having difficulty swallowing" which she had treated with abx and peridex....

...I'm assuming she or he never bothered to look in the persons mouth, because I could see the massive lesion from like two feet away.

And he's now dead.
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i'm beginning to sense a theme here... hellllo antibiotic resistance!
 
BklynRN said:
The cold hard truth about Nurse Practitioners from a R.N.

Yes, the clinical rotations are a joke, I hear this so many times from my co-workers-basically follow someone around for a little while yadda yadda yadda look at a chart yadda yadda yadda that's it, do that for 700 hours and you're done.

Most co-workers in the program are idiots, seriously not being sarcastic, but they are- one told me the other day vaccines still cause autism.

They are not cost effective, they are just referral machines because they lack the ability to comprehend and analyze a patient the way a MD would be able to.

All programs are done online and with zero ability to weed out people who should be in!
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Really, so you think U of Penn's advanced practice programs are all online???? Nah.
 
JustPlainBill said:
Without generalizing -- and this is just my experience -- I have not run into an NP that I would trust with a patient yet -- and the sad part is that they don't know what they don't know -- I've had situations with a family member in the ICU where I was traveling incognito and watched them blow off an SpO2% of 79 and cancel an order by the intensivist for a CXR stating that "I've examined the patient and he doesn't need it" -- I was about to slip out of the room and make a few well placed phone calls when the RT walked in, saw it, and took appropriate action...had another case of being called in for a Hb of 4 which really turned out to be a cluster -- NP sent the patient down for a US to r/o DVT AFTER paging ICU (my team) for an Hb of 4 -- when we got there, the patient was sitting up fat, dumb and happy with bilateral LE edema from a CHF exac -- NP didn't think to repeat labs and treat the patient -- and another one was when an NP student when asked what the fasting CBG value for DM proudly stated "200" -- when f/u questioned about the fasting CBG for pre-diabetes proudly stated "250" and wanted to check microalbumin Qvisit with eye exams Q3 months --- I went into full pimp mode and shark attacked that one -- there were other things in that situation that really pissed me off -- like when they had the balls to tell a colleague that when they graduated from NP school they would be the equivalent of a board certified, FM attending -- in which wet dream was this?

IIRC, a group of them were given a watered down Step2 and there was a 50% failure rate and if you do the "hours" to "hours" they're about the equivalent of an MS2/Ms3 -- 40hrs/wk x 46 weeks (1 month off for summer break between ms1-ms2 and 2 weeks off for Christmas during ms1 year) = 1840 hrs so an MS 2, not counting Christmas break during Ms2 has 2.6 times the number of hours AFTER a BS degree (assuming a 700 hour content block)-- at a minimum they're looking at another 2 years for the MD/DO degree plus 3 years of residency ---

So, no, I don't care for NPs and won't hire them -- and yes, there are lousy doctors out there, I get it -- I'm hoping the docs have the moral courage to say/think -- "I don't know this and I'm dealing with people's lives, so I better either get trained or find something else in medicine that I do know and can do" ---

sorry, thread touched a nerve
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OK, I have to give you the benefit of your experience. Here's mine. As a critical care RN is peds/adults, even w/o the advanced practice education/license, stuff like that would NEVER be missed by the bulk of my critical care nurse colleagues or me.
A 75% can be an ideal SPO2 for someone like a kid with Hypoplastic Left Heart, where you don't want the % > 80 ish or < 73-75%. It depends upon the heart defect and how things are mixing.

Now, in the overwhelming majority of patients, NO. No critical care RN that I respect, much less and advanced nurse practitioner/specialist would just blow that off. I have no idea of where you were working or what kind of folks you were working w, but this is an extreme, ridiculous example. I have been doing this for well over 20 years. In my neck of the woods and in excellent university centers I have worked, it's just not gonna happen. And if some nimrod NP blew such a thing off, you can bet a critical care RN with an ounce of sense is going to go over that person's head and be damned with the consequences.

What you are describing is, at least IMHO, the result of schools not mandating that these RNs have seriously 5 years or more of hard core acute care, full-time. No the schools want money, so they take them fresh out of BSN school, where most know almost nothing and have not had to opportunity to grow and learn by putting together the clinical with didactic. Then they have the nerve to give them a crap amount of required clinical hours. I am fervently against this and have always been. What you are not seeing are those with strong clinical and didactic experience that have done a lot of rodeo tours and have sound judgment. Many of those are retired or retiring or teaching. At one time, strong clinical experience was required beyond whatever GPA or GRE %s. Now, it's like they see them and the schools just start counting the money they will make. And the nursing profession lets it go on. It's wrong.

So I see your point JPBill; but it's so grossly unfair to throw out all of them with the bathwater. I can show you many RNs that are NOT advanced nurse practitioners that no and regularly DO better than that. And I can show you ANPs that do do better than what you describe on a daily basis.

No, I do NOT think they should EVER replace physicians. But I have seen good and bad in both NPs, PAs, MDs, and DOs. Over 20 years has shown me a hell of a lot.

You are painting with too broad of a brush. That's generalizing. Although I do also have issues, as previously stated, with the allowance of sub-bar clinical experience for nursing going into these programs. If I were the big US Nursing Czar, I'd seek to change that. But it's wrong to generalize in the way that ou have. I am very sorry you have had to go through and see these bad examples and have had bad experiences. But your generalization from your experience is NOT correct either.
 
BklynRN said:
You actually don't have to be a NP to make good money in nursing. If you schedule yourself right you can easily make over a 100,000 a year if not more without burning out. You do not need the debt or extra time in school and responsibility to make good money. The biggest lie ever sold by NP programs.
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It's true, at least in my area and specialty. But at some point, you decide that there are limitations in practice, and that you want to learn and do more.

I could probably make $150,000 per year working 60 hours per week. But after you have done pretty much all you can in the field, it's just frustrating b/c you are limited as to what you can do. Of course all areas of medicine somewhat limiting, depending upon what is going on with the patients and/or insurance. But unless you are doing something like psychiatric nurse practitioner, you really aren't functioning autonomously--even in states that are giving more leeway.

And probably of those 60 hours, some regular portion of it would mean 12+ nights plus WEs plus holidays. Done all of that for a long time.

You can do well as a nurse liaison, depending; but it feels like a sales job. You can do great in pharm rep, but lots of travel and again, it feels like a sales job--b/c it actually is.
 
OK I'm confused.

If an NP is employed by a hospital system and working independently, with HR and the bureaucrats making the hiring decisions, do any catastrophes caused by the NP fall onto the hospital executives? The HR/execs did the hiring. If they are employed by a hospital and are acting in a so-called independent manner, their boss is the hospital, and it is the hospital that determined their fitness for practice.

I would think that, kind of like if there were a disaster on a ride at a county fair the lawsuit would be against the fair organization and not the carney in the front, a big NP screwup would be the responsibility of the hospital corporation and would thus make them the liable party, not the NP. The hospital has far deeper pockets than the NP as well, which would make them a more attractive target.

Physicians, all physicians, should man-up and just stop supervising any hospital practice where the NPs are hired by HR/executive. The NP won't answer to the doc, yet the doc will be entirely liable for the NP's malpractice, and HR/exec get a cut-rate provider without taking any of the liability.

If as an independent physician you want to hire an NP, you do it accepting the full risks and responsibilities.
 
DocVapor said:
It's OK, the bugs will all die with the patient.
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Some of them will blossom into incredible physicians.

Meanwhile the extreme mentality seems incredibly ridiculous. Childish generalizations and hateful attitudes against those over which physicians have the extreme advantage. B/c of this advantage, I am not getting the whole "judge by my anecdotal experiences" generalizations and severe NP hate.

Plenty of experienced docs will tell you that they have/do work with some great NPs--unless they feel pressured by some "Boy's Club" bias.

Physicians have the upper hand.

Here is the reality: There are crappy NPs and crappy physicians. Get out of school and practice for a while. You will see it.
 
Psai said:
Money is important but i think what gets nurses is the prestige, the white coat and the extra letters on their name. Also floor nursing sucks, you always have too many patients, too many tasks and too much bs charting
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The wannabe-doc ancillary staff tend to throw the most letters after their name. I don't know what half of them represent and I really don't care. It's just funny.

What's that saying..? The emptiest drum makes the loudest noise.
 
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jl lin said:
Some of them will blossom into incredible physicians.

Meanwhile the extreme mentality seems incredibly ridiculous. Childish generalizations and hateful attitudes against those over which physicians have the extreme advantage. B/c of this advantage, I am not getting the whole "judge by my anecdotal experiences" generalizations and severe NP hate.

Plenty of experienced docs will tell you that they have/do work with some great NPs--unless they feel pressured by some "Boy's Club" bias.

Physicians have the upper hand.

Here is the reality: There are crappy NPs and crappy physicians. Get out of school and practice for a while. You will see it.
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I dont think anyone is arguing this. We're simply sharing our *own* personal observations.
 
jl lin said:
Some of them will blossom into incredible physicians.

Meanwhile the extreme mentality seems incredibly ridiculous. Childish generalizations and hateful attitudes against those over which physicians have the extreme advantage. B/c of this advantage, I am not getting the whole "judge by my anecdotal experiences" generalizations and severe NP hate.

Plenty of experienced docs will tell you that they have/do work with some great NPs--unless they feel pressured by some "Boy's Club" bias.

Physicians have the upper hand.

Here is the reality: There are crappy NPs and crappy physicians. Get out of school and practice for a while. You will see it.
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Wat? I purposefully posted "/sarcasm" after FML's reply so that no-one would get baited by my troll post, but you just couldn't help yourself. I'm both sad for you and oddly impressed with myself at the same time.
 
DocVapor said:
Wat? I purposefully posted "/sarcasm" after FML's reply so that no-one would get baited by my troll post, but you just couldn't help yourself. I'm both sad for you and oddly impressed with myself at the same time.
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What makes you think I was referring to ONLY you?

I am happy for me.

I am sad that some folks have a tendency to broadly bully an entire group based on generalizations. I find this phenomenon fascinating--the need to put down others in order to somehow feel superior--especially when in fact yours, professionally speaking, is already the superior position. It's just odd to me is all.

I might be impressed with you if I knew you better; but b/c you reacted thinking I was somehow only singling you out...well.... What did you want me to do dude? Quote all the back and forth hits and banter? Sorry, yours was the latest and easiest to quote at that time.

I wouldn't worry about it, just as I am not going to worry about this weird nurse-hate junk that will invariably dissipate with experience--at least with mature and reasonable people.

And now I don't care anymore, b/c this whole thing is boring, tired, nonsense. But it does make a periodic comeback when I guess there is nothing else to bitch about. Trust me. Nurses know about some of the disrespect--they know full well that @#$% runs downhill. 🙂 Most of them just get over it and go on with their lives. 😉
 
jl lin said:
Really, so you think U of Penn's advanced practice programs are all online???? Nah.
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It isn't about the best NP programs. It's about the majority of them. Most programs are terrible, with only a couple dozen really good ones. And even the really good ones in no way make a nurse as competent as an attending physician.
 
BklynRN said:
You actually don't have to be a NP to make good money in nursing. If you schedule yourself right you can easily make over a 100,000 a year if not more without burning out. You do not need the debt or extra time in school and responsibility to make good money. The biggest lie ever sold by NP programs.
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Never wiping ass again is priceless though.
 
jl lin said:
Really, so you think U of Penn's advanced practice programs are all online???? Nah.
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They may not be online, but they still don't hold a candle to medical school, internship, and a primary care residency.
There's one OR nurse I can't stand, she's in an NP program now. I think I would donate tuition money to help pay for it if I had to, just to get her out of my ORs.
Fair winds and following seas...
 
jl lin said:
OK, I have to give you the benefit of your experience. Here's mine. As a critical care RN is peds/adults, even w/o the advanced practice education/license, stuff like that would NEVER be missed by the bulk of my critical care nurse colleagues or me.
A 75% can be an ideal SPO2 for someone like a kid with Hypoplastic Left Heart, where you don't want the % > 80 ish or < 73-75%. It depends upon the heart defect and how things are mixing.

Now, in the overwhelming majority of patients, NO. No critical care RN that I respect, much less and advanced nurse practitioner/specialist would just blow that off. I have no idea of where you were working or what kind of folks you were working w, but this is an extreme, ridiculous example. I have been doing this for well over 20 years. In my neck of the woods and in excellent university centers I have worked, it's just not gonna happen. And if some nimrod NP blew such a thing off, you can bet a critical care RN with an ounce of sense is going to go over that person's head and be damned with the consequences.

What you are describing is, at least IMHO, the result of schools not mandating that these RNs have seriously 5 years or more of hard core acute care, full-time. No the schools want money, so they take them fresh out of BSN school, where most know almost nothing and have not had to opportunity to grow and learn by putting together the clinical with didactic. Then they have the nerve to give them a crap amount of required clinical hours. I am fervently against this and have always been. What you are not seeing are those with strong clinical and didactic experience that have done a lot of rodeo tours and have sound judgment. Many of those are retired or retiring or teaching. At one time, strong clinical experience was required beyond whatever GPA or GRE %s. Now, it's like they see them and the schools just start counting the money they will make. And the nursing profession lets it go on. It's wrong.

So I see your point JPBill; but it's so grossly unfair to throw out all of them with the bathwater. I can show you many RNs that are NOT advanced nurse practitioners that no and regularly DO better than that. And I can show you ANPs that do do better than what you describe on a daily basis.

No, I do NOT think they should EVER replace physicians. But I have seen good and bad in both NPs, PAs, MDs, and DOs. Over 20 years has shown me a hell of a lot.

You are painting with too broad of a brush. That's generalizing. Although I do also have issues, as previously stated, with the allowance of sub-bar clinical experience for nursing going into these programs. If I were the big US Nursing Czar, I'd seek to change that. But it's wrong to generalize in the way that ou have. I am very sorry you have had to go through and see these bad examples and have had bad experiences. But your generalization from your experience is NOT correct either.
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Did you just throw the HLH thing in there to show us how smart you are or something? Cause it was totally irrelevant to the rest of the post...I think it was pretty clear he was talking about an adult family member who didn't have a congenital heart defect.
 
It's funny how they it says NP's are as competent as doctors, by using the *700 hours of on the job training* tagline. I forget, is that as many hours that docs go through in residency?:whistle::whistle::whistle: But ultimately in the end it depends on the person. There will be lazy docs where a competent and excelling NP might exceed the medical care that would be given by said docs.
 
Chemdude said:
I understand that medical knowledge has increased exponentially in recent years. Nonetheless, I don't think that this should necessitate that everyone become a specialist. Why are only 20% of IM residents going into primary care? Do we really need more orthopedic surgeons to do hip replacements on 75-year-old ladies with 5 comorbidities? There are other countries with comparable quality of healthcare that don't have nearly as much specialists as we do. For example, look at the Canadian system; only a small fraction of each medical school class chooses to go into a specialty field.
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That's because the pay is non-comparable to the specialties in the U.S. The PC docs earn more on average than ours, but the specialty doctors earn considerably lower than ours as well.
 
DokterMom said:
'Lobbying' does not equal demonstrating in the streets or time-consuming sit-ins. More often, it means writing a check to a lobbying firm to lobby effectively on your behalf. And before you say that med students don't have any money (I know, I know) let me point out that physicians do, and they need to part with a bit more of it to protect their future interests and the welfare of their patients.

There's a proper place for NPs; and in an appropriate role, NPs have a lot to contribute to US healthcare. But if you let the NP lobby define that role and that place, don't be surprised if you don't like the results.
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There's 3 different types of lobbying, 1 being grassroots lobbying which is exactly what demonstrating and sit- ins are. They let the policy creators know what the public wants which can influence public policy. Look at Obama, back in the past he was against gay marriage. There's a video of him speaking about how he believes that marriage is between a man and a women. Through the shift in public opinion and widespread agreement in the states, his stance was changed on the matter. That is Grassroots lobbying. There's thousands of more examples of this.
 
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jl lin said:
It's true, at least in my area and specialty. But at some point, you decide that there are limitations in practice, and that you want to learn and do more.

I could probably make $150,000 per year working 60 hours per week. But after you have done pretty much all you can in the field, it's just frustrating b/c you are limited as to what you can do. Of course all areas of medicine somewhat limiting, depending upon what is going on with the patients and/or insurance. But unless you are doing something like psychiatric nurse practitioner, you really aren't functioning autonomously--even in states that are giving more leeway.

And probably of those 60 hours, some regular portion of it would mean 12+ nights plus WEs plus holidays. Done all of that for a long time.

You can do well as a nurse liaison, depending; but it feels like a sales job. You can do great in pharm rep, but lots of travel and again, it feels like a sales job--b/c it actually is.
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Well not for me.. I work one job 9AM-5PM and make over 100,000... so no I'm not overworked...
 
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Very easy way for you MD's to stop NP's just simply 1) stop hiring them at your practices 2) stop agreeing to shadowing opportunities during NP school 3) Lobby for stricter rules/regulations in the hospital such as not letting their mistakes fall on your licenses..... but number one way is to stop hiring them!
 
BklynRN said:
I never had to... I was always very good friends with the CNA's
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Totally depends on where you work- my hospital was really great at staffing nurses, but really poor at staffing CNAs, so nurses ended up with a lot of the grunt work. Pay was great though, most nurses with 10 years experience could crack 100k averaging 44 hours a week.
 
jl lin said:
What makes you think I was referring to ONLY you?

I am happy for me.

I am sad that some folks have a tendency to broadly bully an entire group based on generalizations. I find this phenomenon fascinating--the need to put down others in order to somehow feel superior--especially when in fact yours, professionally speaking, is already the superior position. It's just odd to me is all.

I might be impressed with you if I knew you better; but b/c you reacted thinking I was somehow only singling you out...well.... What did you want me to do dude? Quote all the back and forth hits and banter? Sorry, yours was the latest and easiest to quote at that time.

I wouldn't worry about it, just as I am not going to worry about this weird nurse-hate junk that will invariably dissipate with experience--at least with mature and reasonable people.

And now I don't care anymore, b/c this whole thing is boring, tired, nonsense. But it does make a periodic comeback when I guess there is nothing else to bitch about. Trust me. Nurses know about some of the disrespect--they know full well that @#$% runs downhill. 🙂 Most of them just get over it and go on with their lives. 😉
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What made me think you were referring to me? Oh I dunno, you quoted me. Why wouldn't I think you were singling me out? If you wanted to make a more general statement... don't quote anyone and make it clear that you're directing your comment to multiple people. I mean it is possible to do that without getting your whole point lost in some weird internet chest-thumping contest like we are having right now.
 
W19 said:
As a physician you won't help a nurse/CNA clean up a patient!
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There's a lot of things I'll help with, but bowel movements are one of those things I generally try to avoid. In a pinch, I'll help turn a patient for cleanup, but let's just say there's a reason I was a respiratory therapist and not a nurse, and that reason was very much tied to my having to do nothing below the waist. Which might also explain my interest in psych...
 
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jl lin said:
OK, I have to give you the benefit of your experience. Here's mine. As a critical care RN is peds/adults, even w/o the advanced practice education/license, stuff like that would NEVER be missed by the bulk of my critical care nurse colleagues or me.
A 75% can be an ideal SPO2 for someone like a kid with Hypoplastic Left Heart, where you don't want the % > 80 ish or < 73-75%. It depends upon the heart defect and how things are mixing.

Now, in the overwhelming majority of patients, NO. No critical care RN that I respect, much less and advanced nurse practitioner/specialist would just blow that off. I have no idea of where you were working or what kind of folks you were working w, but this is an extreme, ridiculous example. I have been doing this for well over 20 years. In my neck of the woods and in excellent university centers I have worked, it's just not gonna happen. And if some nimrod NP blew such a thing off, you can bet a critical care RN with an ounce of sense is going to go over that person's head and be damned with the consequences.

What you are describing is, at least IMHO, the result of schools not mandating that these RNs have seriously 5 years or more of hard core acute care, full-time. No the schools want money, so they take them fresh out of BSN school, where most know almost nothing and have not had to opportunity to grow and learn by putting together the clinical with didactic. Then they have the nerve to give them a crap amount of required clinical hours. I am fervently against this and have always been. What you are not seeing are those with strong clinical and didactic experience that have done a lot of rodeo tours and have sound judgment. Many of those are retired or retiring or teaching. At one time, strong clinical experience was required beyond whatever GPA or GRE %s. Now, it's like they see them and the schools just start counting the money they will make. And the nursing profession lets it go on. It's wrong.

So I see your point JPBill; but it's so grossly unfair to throw out all of them with the bathwater. I can show you many RNs that are NOT advanced nurse practitioners that no and regularly DO better than that. And I can show you ANPs that do do better than what you describe on a daily basis.

No, I do NOT think they should EVER replace physicians. But I have seen good and bad in both NPs, PAs, MDs, and DOs. Over 20 years has shown me a hell of a lot.

You are painting with too broad of a brush. That's generalizing. Although I do also have issues, as previously stated, with the allowance of sub-bar clinical experience for nursing going into these programs. If I were the big US Nursing Czar, I'd seek to change that. But it's wrong to generalize in the way that ou have. I am very sorry you have had to go through and see these bad examples and have had bad experiences. But your generalization from your experience is NOT correct either.
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I see your point -- and yes, I've worked with some spot on RNs that I would trust with my own family -- recently I've noticed a trend, especially among the new grads to be a little cocky -- but then again, that probably goes with all new grads -- figure you've got the world by the balls.

This DNP was a critical care RN, willfully chose to ignore this in a 75 y/o patient s/p posterior wall MI who had a PHx of triple bypass and stent placement who was obviously working to breathe-- this particular RN was more concerned with showing how much they knew and how much "responsibility" they had, rather than doing what had to be done. I try not to mess around in other people's sandboxes, but in my estimation at the time, this was about to cause some issues with someone near and dear to me --

Yes, I recall patients coming into the ICU from one practice that we dreaded as residents as a particular physician struck us as particularly clueless -- I grant your point that it does run across all lines.

I guess what I find most irritating is the absolute refusal to have a good sense of introspection about the knowledge base they have and then have the absolute chutzpah to try to pass themselves off as having an equal knowledge/experience base of an attending physician and then to play the "we care about the patient as a whole person" and make like the rest of us don't -- maybe in a wet dream, but not in reality....

Diploma mills suck no matter the profession or level ---
 
IlDestriero said:
They may not be online, but they still don't hold a candle to medical school, internship, and a primary care residency.
There's one OR nurse I can't stand, she's in an NP program now. I think I would donate tuition money to help pay for it if I had to, just to get her out of my ORs.
Fair winds and following seas...
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Yea. That's the thing. It's a person you don't like. It doesn't mean everyone.
 
JustPlainBill said:
I see your point -- and yes, I've worked with some spot on RNs that I would trust with my own family -- recently I've noticed a trend, especially among the new grads to be a little cocky -- but then again, that probably goes with all new grads -- figure you've got the world by the balls.

This DNP was a critical care RN, willfully chose to ignore this in a 75 y/o patient s/p posterior wall MI who had a PHx of triple bypass and stent placement who was obviously working to breathe-- this particular RN was more concerned with showing how much they knew and how much "responsibility" they had, rather than doing what had to be done. I try not to mess around in other people's sandboxes, but in my estimation at the time, this was about to cause some issues with someone near and dear to me --

Yes, I recall patients coming into the ICU from one practice that we dreaded as residents as a particular physician struck us as particularly clueless -- I grant your point that it does run across all lines.

I guess what I find most irritating is the absolute refusal to have a good sense of introspection about the knowledge base they have and then have the absolute chutzpah to try to pass themselves off as having an equal knowledge/experience base of an attending physician and then to play the "we care about the patient as a whole person" and make like the rest of us don't -- maybe in a wet dream, but not in reality....

Diploma mills suck no matter the profession or level ---
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Well said. Ultimately, I don't see them as the threat that some med students and newer docs may see them. The biggest problem I have seen, as I said already, is when they take people into programs and they just don't have strong clinical experience over full-time years. Personally, I would make it so you had to have strong, full-time, acute/critical care experience from legitimate centers at least over 5 years before they could even apply. But that's not gonna make schools as much money.

Make no mistake about it though. I have seen ego and arrogance from NPs, PAs, and Docs that have caused problems for patients. This is NOT something you only see from NPs. I have seen it from RNs. I have seen it from RRTs. It's more aggravating than out and out stupidity, b/c when someone KNOWS to do better and doesn't, that just downright unethical CRAP.
 
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IlDestriero said:
I'm not sure what you mean. I didn't say NPs are stupid, just that they are miles behind a fully trained PCP.
Though this particular nurse IS a dunce and I'm sure she will be both arrogant and dangerous when she's done.
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But I have found that good NPs work with experienced attendings and learn from them. I have no objection to competent and good NPs except when they assert a level that is equal to that of a committed, highly experienced physician. There is a limit to the scope of their practice, and that's fine. Just accept and do your best to do well that which you can do. My work as an RN is no less valid than that of a physician. It's just different, and we are all there to help the patients. End of story. The scary part is where hospitals use NPs in place of experienced physicians b/c it's cheaper. Of course this is going to end up biting someone in the butt.
 
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Mad Jack said:
There's a lot of things I'll help with, but bowel movements are one of those things I generally try to avoid. In a pinch, I'll help turn a patient for cleanup, but let's just say there's a reason I was a respiratory therapist and not a nurse, and that reason was very much tied to my having to do nothing below the waist. Which might also explain my interest in psych...
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I was with you right up to the point about competence. If an NP is taught how to do a physical exam by a physician and becomes competent in completing them by experience and such, this is an area where both a physician and NP may well be equally competent. I know that I am better than some docs at hearing heart sounds, b/c I have become experienced and learned and practiced in heart sounds. It takes time and some people are better at it than others. It doesn't mean I am a competent cardiologist though for God's sake. But there are skills and didactic insight and such in which the PA, NP, and physician may or may not be more or less competent.

And there are less competent physicians, where in fact, some NPs or PAs are a sight better--b/c they have expanded their knowledge and just really give a damn to build their level of competence. There indeed are physicians, where, regardless of their education and residency, just aren't that good at what they do and are not competent practitioners. Are they more competent than those experience and continually learned NPs and PAs that do actually give a damn about what they are doing and are bright and committed? No.

Bill made some good points. But some of this stuff is just about a pissing contest, which really isn't a pissing contest, b/c on the whole, physicians have the advantage, hands down. So why all the NP and/or PA hate?

End of the day, it is up to each practitioner to be as competent as possible--from a professional standpoint and from an ethical one.
 
jl lin said:
I was with you right up to the point about competence. If an NP is taught how to do a physical exam by a physician and becomes competent in completing them by experience and such, this is an area where both a physician and NP may well be equally competent. I know that I am better than some docs at hearing heart sounds, b/c I have become experienced and learned and practiced in heart sounds. It takes time and some people are better at it than others. It doesn't mean I am a competent cardiologist though for God's sake. But there are skills and didactic insight and such in which the PA, NP, and physician may or may not be more or less competent.

And there are less competent physicians, where in fact, some NPs or PAs are a sight better--b/c they have expanded their knowledge and just really give a damn to build their level of competence. There indeed are physicians, where, regardless of their education and residency, just aren't that good at what they do and are not competent practitioners. Are they more competent than those experience and continually learned NPs and PAs that do actually give a damn about what they are doing and are bright and committed? No.

Bill made some good points. But some of this stuff is just about a pissing contest, which really isn't a pissing contest, b/c on the whole, physicians have the advantage, hands down. So why all the NP and/or PA hate?

End of the day, it is up to each practitioner to be as competent as possible--from a professional standpoint and from an ethical one.
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There is no PA hate. They don't claim to be equivalent.
 
jl lin said:
I was with you right up to the point about competence. If an NP is taught how to do a physical exam by a physician and becomes competent in completing them by experience and such, this is an area where both a physician and NP may well be equally competent. I know that I am better than some docs at hearing heart sounds, b/c I have become experienced and learned and practiced in heart sounds. It takes time and some people are better at it than others. It doesn't mean I am a competent cardiologist though for God's sake. But there are skills and didactic insight and such in which the PA, NP, and physician may or may not be more or less competent.

And there are less competent physicians, where in fact, some NPs or PAs are a sight better--b/c they have expanded their knowledge and just really give a damn to build their level of competence. There indeed are physicians, where, regardless of their education and residency, just aren't that good at what they do and are not competent practitioners. Are they more competent than those experience and continually learned NPs and PAs that do actually give a damn about what they are doing and are bright and committed? No.

Bill made some good points. But some of this stuff is just about a pissing contest, which really isn't a pissing contest, b/c on the whole, physicians have the advantage, hands down. So why all the NP and/or PA hate?

End of the day, it is up to each practitioner to be as competent as possible--from a professional standpoint and from an ethical one.
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This is the whole point though. Yes, an NP may have the ability to learn the physical exam well; this is an art unto itself and certainly takes years to truly master for anyone regardless of degree. However, NPs still don't have the deeper level of understanding of disease processes and/or pathophysiology and/or presentations of diseases, particularly more obscure disorders. So in some cases they don't have an adequate knowledge of what they should be looking for, what exam findings are pertinent, etc. Without attending medical school, it's still more algorithmic than analytic. NPs can go through the same motions of a physical exam as an MD/DO without the deeper level of cognitive evaluation. And there's the problem. Typically it's not the simple bread-and-butter cases that NPs have problems with, it's subtle, difficult-to-distinguish ones that require a more complex understanding. Physicians are seeing the same data points of the physical exam but analyzing them in a different way.
 
skipdivided said:
This is the whole point though. Yes, an NP may have the ability to learn the physical exam well; this is an art unto itself and certainly takes years to truly master for anyone regardless of degree. However, NPs still don't have the deeper level of understanding of disease processes and/or pathophysiology and/or presentations of diseases, particularly more obscure disorders. So in some cases they don't have an adequate knowledge of what they should be looking for, what exam findings are pertinent, etc. Without attending medical school, it's still more algorithmic than analytic. NPs can go through the same motions of a physical exam as an MD/DO without the deeper level of cognitive evaluation. And there's the problem. Typically it's not the simple bread-and-butter cases that NPs have problems with, it's subtle, difficult-to-distinguish ones that require a more complex understanding. Physicians are seeing the same data points of the physical exam but analyzing them in a different way.
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I agree, and this is why I choose MS over NP school. This is why those in my family that have serious comordid/complex issues see a reputable physician--and I really check them out ahead of time, if I don't know them already.

It should be clear that ML practice by necessity has to be limited. It still doesn't mean that some of them are not more competent than some rare number of doctors. I have seen this first hand. There are also scary, incompetent docs out there with the full MS credentials, etc. You will see them in time. And yes. I have seen PAs that thought they were equal to docs and God's gift to medicine. I have seen them miss important stuff. The level of selectivity here is very interesting to me. The anti-nurse crap really has to stop. And yes, I agree with JPBill. There are foolhardy RNs that either never should have made it through NS or they passed NCLEX with a crappy P/F, which wasn't the deal when I became an RN. And those RNs annoy the crap out of me as well.
 
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