"The Nursing Mindset"

[RNtoMD87]

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I've been told some Med schools don't like taking nurses that are too "deeply indoctrinated".

For physicians or adcoms- what particularly about the "nursing mindset" do you find flawed or dislike?

 

[NITRAS]

I'm not and adcom, and not entirely sure what indoctrination some one is referring to, but nursing work is much different than physician work. You have healthcare experience, yes, but being proficient in nursing won't make you a good doctor.

 

[RNtoMD87]

I'm not and adcom, and not entirely sure what indoctrination some one is referring to, but nursing work is much different than physician work. You have healthcare experience, yes, but being proficient in nursing won't make you a good doctor.

I’m not saying it will, but I’ve had some people tell me being a nurse is a negative- not a neutral.

“We don’t like taking nurses with over 5 years experience” it makes me feel like I am a ticking time bomb where I have to hurry up and get out of nursing before the timer expires.

I don’t see how it’s less conducive to being a doctor than any other career.

 

[Matthew9Thirtyfive]

I’m guessing it depends on how you present yourself, just like any other applicant with lots of healthcare experience. I have a decade of healthcare experience. If I go in there and act like I know what it’s like being a doctor and that med school is a formality, it probably won’t go over too well.

 

[RNtoMD87]

I’m guessing it depends on how you present yourself, just like any other applicant with lots of healthcare experience. I have a decade of healthcare experience. If I go in there and act like I know what it’s like being a doctor and that med school is a formality, it probably won’t go over too well.

I mean that wouldnt faire well for anyone. But I’ve heard many times about criticisms of “the nursing mindset”, which I have my idea what the nursing mindset is but I don’t understand what negative can be meant by it. I have major problems with nursing education (lack of science knowledge and disease pathology mostly) but the job itself I don’t understand an issue with it. I don’t see why being a nurse is more of a negative than being an EKG tech, scribe, phlebotomist etc.

 

[Matthew9Thirtyfive]

I mean that wouldnt faire well for anyone. But I’ve heard many times about criticisms of “the nursing mindset”, which I have my idea what the nursing mindset is but I don’t understand what negative can be meant by it. I have major problems with nursing education (lack of science knowledge and disease pathology mostly) but the job itself I don’t understand an issue with it. I don’t see why being a nurse is more of a negative than being an EKG tech, scribe, phlebotomist etc.

Having worked with nurses for a long time and being married to one (though my wife isn’t really like this), I’m betting it’s the idea that nurses somehow are protecting the patient from the rude, snobby doctors who don’t care about them and make tons of mistakes. I’ve heard a lot of nurses trash talk physicians and their decisions based on their limited knowledge and mostly it seems like they just like to hear themselves talk or seem smart.

Just don’t badmouth any physicians or nurses, and make sure you come across as knowing you have just as much to learn as any other premed and I’m sure you’ll be fine.

 

[RNtoMD87]

Having worked with nurses for a long time and being married to one (though my wife isn’t really like this), I’m betting it’s the idea that nurses somehow are protecting the patient from the rude, snobby doctors who don’t care about them and make tons of mistakes. I’ve heard a lot of nurses trash talk physicians and their decisions based on their limited knowledge and mostly it seems like they just like to hear themselves talk or seem smart.

Just don’t badmouth any physicians or nurses, and make sure you come across as knowing you have just as much to learn as any other premed and I’m sure you’ll be fine.

I see this a lot with old nurses, the same ones who can’t take criticism. I really can’t wait to be out of this field. The younger ones I don’t have as much trouble with.

It has been incredibly difficult going from dropping people for making mistakes, to merely pointing out their mistakes and having them report me for “bullying them” regardless of how nice I say it. It’s like I’m supposed to ignore their f- ups.

 

[Matthew9Thirtyfive]

I see this a lot with old nurses, the same ones who can’t take criticism. I really can’t wait to be out of this field. The younger ones I don’t have as much trouble with.

It has been incredibly difficult going from dropping people for making mistakes, to merely pointing out their mistakes and having them report me for “bullying them” regardless of how nice I say it. It’s like I’m supposed to ignore their f- ups.

Yeah the civilian world is much different.

 

[getdown]

I've been told some Med schools don't like taking nurses that are too "deeply indoctrinated".

For physicians or adcoms- what particularly about the "nursing mindset" do you find flawed or dislike?

I'm not an adcom either but one thing that could be potentially a negative is the identifying and diagnosis. By virtue of experience nurses are very good at idenfying common problems. They see certain patterns and immediately think it's X that's causing it. AAlot if times they are right but sometimes theres a nuance theyre missing that could really effect the patient when a different Especiallytherapy is startrd. if you've worked as a nurse for a long time this could become engrained in your decision making process. However as a physician the thought process cannot be to too quickly jump to something. You have to have a differential of what is most likely and then be able to identify when something looks like a common problem but is actually something else. I think that is the biggest issue with what you say is the "nursing mindset". New med students don't have that decision algorithm already built in and have to relearn how they approach medicine.

 

[RNtoMD87]

I'm not an adcom either but one thing that could be potentially a negative is the identifying and diagnosis. By virtue of experience nurses are very good at idenfying common problems. They see certain patterns and immediately think it's X that's causing it. AAlot if times they are right but sometimes theres a nuance theyre missing that could really effect the patient when a different Especiallytherapy is startrd. if you've worked as a nurse for a long time this could become engrained in your decision making process. However as a physician the thought process cannot be to too quickly jump to something. You have to have a differential of what is most likely and then be able to identify when something looks like a common problem but is actually something else. I think that is the biggest issue with what you say is the "nursing mindset". New med students don't have that decision algorithm already built in and have to relearn how they approach medicine.

Hmmm. That’s a very good point

 

[deleted480308]

I’m not saying it will, but I’ve had some people tell me being a nurse is a negative- not a neutral.

“We don’t like taking nurses with over 5 years experience” it makes me feel like I am a ticking time bomb where I have to hurry up and get out of nursing before the timer expires.

I don’t see how it’s less conducive to being a doctor than any other career.

I don’t think it is less conducive... as long as you aren’t “that” nurse

The problem is convincing adcoms that you aren’t like that bad stereotype that all of us have seen a few examples of with the “i’ve been on this floor for 23yrs so (proceeds to tell doctor how to do their job)”. I generally like my nurses and appreciate the input of a really experienced one but every now and then one acts all crazy

I had a freind apply and they phrased it as “I’m a good nurse but I don’t want to be a nurse, I want to be a doctor”

 

[RNtoMD87]

I don’t think it is less conducive... as long as you aren’t “that” nurse

The problem is convincing adcoms that you aren’t like that bad stereotype that all of us have seen a few examples of with the “i’ve been on this floor for 23yrs so (proceeds to tell doctor how to do their job)”. I generally like my nurses and appreciate the input of a really experienced one but every now and then one acts all crazy

I had a freind apply and they phrased it as “I’m a good nurse but I don’t want to be a nurse, I want to be a doctor”

I definitely don’t know everything. I see myself as an average to slightly above average knowledge step down nurse and beginner ICU nurse. New nurses come to me often, and experienced nurses occasionally ask me things. I try to stay teachable. Being flexible with new evidence based practice guidelines etc. it’s hard sometimes but you have to check your ego.

I still make mistakes but I just bite the bullet and accept that. We all f up. But people who can’t admit that they f’ed up are what infuriate me. Own up to it.

I remember about a year ago, I checked a glucose and got like 350. Treated it, and then thought about it and said “hmm, that persons glucose is never that high. Let me go recheck it. In the other hand it was 95. (No dextrose going and patient hadn’t been eating. Still a mystery to me). Had them drink a bunch of sugary orange juice and call the doctor. He sounded perplexed that I even bothered letting him know this I guess since I fixed it but I wanted to cover my ass, and most importantly guarantee the patients safety.

 

[FCMike11]

Fascinating.

Sure this is anecdotal, but it was big plus for me and often was part of their conversation with questions they wanted to ask me. I haven't really ever heard anything to contrary of this (what you are mentioning now).

This is with eight years of experience as an RN.

Sent from my SM-G892A using SDN mobile

 

[RNtoMD87]

Fascinating.

Sure this is anecdotal, but it was big plus for me and often was part of their conversation with questions they wanted to ask me. I haven't really ever heard anything to contrary of this (what you are mentioning now).

This is with eight years of experience as an RN.

Sent from my SM-G892A using SDN mobile

Most doctors I discuss it with tell me “you’re a nurse! You should be good as long as your grades and MCAT are good!” On one end of the spectrum, but I’ve spoken to some adcom members who told me the opposite. It seems to be a real toss up.

 

[gonnif]

The OPs viewpoint is a persistent myth that is quite inaccurate.

Having been focusing on nontrads for nearly two decades and having been in involved with the workflow and automation of the application process across multiple schools, it has been my experience from both advisor side and the applicant side, long-experienced nurses , along with MCAT and GPA, are highly competitive. Indeed, a past president of the AMA board of trustees, was a critical care nurse for 11 years prior to starting medical school at age 35. My oldest advisees were in their 40s and 50s (yes 50s) were a long time RN and and Nurse Midwife. One of the Ivies had an adcom who had been an NP prior to medical school (who attended the ivy). Like many nontrads, spending a few years with success in another area/field, shows motivation, commitment, and often health-care experience, thus having the understanding and maturity to make the informed decision of medical school.

If anything, I find younger nurses have more of an issue with adcoms. It is generally thought that trying to jump from earning a BSN to MD partly due to the "commitment" issue: if you werent committed to nursing, how do we know you will be committed to medicine. It should also be noted that many nursing and other allied health/specialized health majors have the worst rate of acceptance to medical schools across broad categories of majors. When I looked at some 10 years or more ago for some conference, my thoughts were that: 1) often they have narrow, specific science prereqs that are not accepted by medical schools; 2) same prereqs are less rigorous and do not prepare them for MCAT as well; 3) nursing school is not easy and GPAs can be lower; 4) often they apply as older, working nurses with full-time employment and family obligations, leaving less time for MCAT prep and applications; 5) have little or no no advising.

And all the above is essentially meaningless to you. You are a nurse, you have long experience, and you are applying to medical school. Focusing on something that you cannot change is an task of utter futility doing nothing but causing worry and stress. So get your head out from where ever it is stuck, look up, and move on. Or in the immortal words of Cher

 

[Goro]

I've been told some Med schools don't like taking nurses that are too "deeply indoctrinated".

For physicians or adcoms- what particularly about the "nursing mindset" do you find flawed or dislike?

I have no problems with nurses as candidates for medical school.

A lot of the hate you see towards nurses and other mid-levels on SDN is not due to fear of compromised patient safety, nor even competition for remuneration, but rather it's the mindset of "how dare those peasants rise above their station!"

Those who think that they are God's anointed tend to get upset when they see threats to their egos.

 

[NITRAS]

I'd have a real good answer to the questions:
Why did you go to RN school if you wanted to be a doctor?
Why not go the nurse practitioner route/ CRNA/ RN administration?

If you can answer those, I think your fine.

 

[RNtoMD87]

I'd have a real good answer to the questions:
Why did you go to RN school if you wanted to be a doctor?
Why not go the nurse practitioner route/ CRNA/ RN administration?

If you can answer those, I think your fine.

That’s my problem. I’ve had many of my doctor buds read my personal statement and they say it’s VERY good, except addressing why medicine. The reason I like medicine is because I can achieve a greater level of knowledge while still in a job where I directly see the impact it makes on a patient. (This is why I don’t think I’d enjoy research. I like a little instant gratification in that way).

But every thing I come up with is “you can do that as an NP” or “why not do research”.


And the reason I chose RN is a mixture of: not even understanding the difference, (coming out of the Army with a background in law enforcement. I didn’t even know what a resident meant), thinking my 2.3 pre Army GPA had ruined any chances, needing a job ASAP because my dad had just died, there were many reasons.

I guess to sum it up “I’m in a much better place now”

 

[Matthew9Thirtyfive]

That’s my problem. I’ve had many of my doctor buds read my personal statement and they say it’s VERY good, except addressing why medicine. The reason I like medicine is because I can achieve a greater level of knowledge while still in a job where I directly see the impact it makes on a patient. (This is why I don’t think I’d enjoy research. I like a little instant gratification in that way).

But every thing I come up with is “you can do that as an NP” or “why not do research”.


And the reason I choose RN is a mixture of: not even understanding the difference, (coming out of the Army with a background in law enforcement. I didn’t even know what a resident meant), thinking my 2.3 pre Army GPA had ruined any chances, needing a job ASAP because my dad had just died, there were many reasons.

I guess to sum it up “I’m in a much better place now”

You want to be a physician and not a mid level because in your experience there is a knowledge gap that you want to be on the other side of and that while mid levels do enjoy a lot of autonomy, there are many fields where if you want complete independence or to be in a leadership position in the healthcare team, you need to be a physician. You’re not doing neurosurgery or being the primary on a total knee as an NP.

 

[RNtoMD87]

You want to be a physician and not a mid level because in your experience there is a knowledge gap that you want to be on the other side of and that while mid levels do enjoy a lot of autonomy, there are many fields where if you want complete independence or to be in a leadership position in the healthcare team, you need to be a physician. You’re not doing neurosurgery or being the primary on a total knee as an NP.

When I say that though it’s “putting down on NPs”

And that’s “ focusing on me and not the patient”

 

[Matthew9Thirtyfive]

When I say that though it’s “putting down on NPs”

And that’s “ focusing on me and not the patient”

It’s not putting down NPs to correctly assess the difference between a mid level and a physician. If you want to focus less on you, just frame it in a way where you say you want to have the most knowledge possible to take care of the patient.

 

[deleted480308]

When I say that though it’s “putting down on NPs”

And that’s “ focusing on me and not the patient”

doctors don't think that's putting anyone down

 

[RNtoMD87]

I had people tell me saying “I value over 9 years of education versus two.” Was looking down upon them.

 

[deleted480308]

I had people tell me saying “I value over 9 years of education versus two.” Was looking down upon them.

That’s discernment that a doctor is more educated than a RN, and it’s true

It can be said in a mean way but it is accurate

 

[RNtoMD87]

That’s discernment that a doctor is more educated than a RN, and it’s true

It can be said in a mean way but it is accurate

Hm that’s exactly how I said it and several statement readers on here and doctors I asked to review it I work with all said that. They told me not to point out the specific differences so this exerpt is my latest “ friends and coworkers have suggested I become a nurse practitioner, but I didn’t anticipate satisfaction with this route. I desire the rigorous education that comes with the medical education track. “

 

[IMGASMD]

It’s not putting down NPs to correctly assess the difference between a mid level and a physician. If you want to focus less on you, just frame it in a way where you say you want to have the most knowledge possible to take care of the patient.

Knowledge and responsibility, ownership.

Have you presented M/M? Have you seen one?
Just checked, probably not, since you are applying to medical school. But just imaging Grey’s anatomy, without all the pretty people and an actual human being is dead/severely harmed, due to your actions, or your inactions or your lack of knowledge. Is that picture sinking in? All the eyes on you, your attendings, all your peers looking at you. And only you and you alone actually know what happened. That’s the level of responsibility and knowledge that all doctors are training towards. The patient is not yours for 8, 12 hour. The patient is yours forever.

I think you’ve received a lot of thoughtful answers. I don’t think it’s a genuine question if someone should ask why not NP, but you should have an answer.

And think about the scene that I’ve set for you in the beginning. Is that what you inspired to do/be? When **** hits the fan, you’re the one that can step up AND actually have the knowledge and experience to back your decisions up, now that’s a doctor.

I am certainly not there yet, but hopefully everyday that I practice, I am one step closer.

Good luck

 

[Hawkenthesky]

I think another point you can mention (which has kind of already been alluded to by others but maybe not explicitly described) is what exactly it is about the role of the physician vs. nurse or NP on the care team that you identify with, and how you feel better suited for that role and why that role is more appealing to you. While NPs do experience much more autonomy than RNs, they do not hold as much authority or autonomy of leadership as physicians. I think most people in healthcare are naturally empathetic and altruistic (to some degree at least), but not every one in healthcare is a natural leader. I think you can discuss how you feel yourself more poised to function in a leadership role, and describe your personal leadership style, and how you think you can apply your tendency/desire/willingness to lead specifically as a physician, versus some other health profession.

 

[RNtoMD87]

Knowledge and responsibility, ownership.

Have you presented M/M? Have you seen one?
Just checked, probably not, since you are applying to medical school. But just imaging Grey’s anatomy, without all the pretty people and an actual human being is dead/severely harmed, due to your actions, or your inactions or your lack of knowledge. Is that picture sinking in? All the eyes on you, your attendings, all your peers looking at you. And only you and you alone actually know what happened. That’s the level of responsibility and knowledge that all doctors are training towards. The patient is not yours for 8, 12 hour. The patient is yours forever.

I think you’ve received a lot of thoughtful answers. I don’t think it’s a genuine question if someone should ask why not NP, but you should have an answer.

And think about the scene that I’ve set for you in the beginning. Is that what you inspired to do/be? When **** hits the fan, you’re the one that can step up AND actually have the knowledge and experience to back your decisions up, now that’s a doctor.

I am certainly not there yet, but hopefully everyday that I practice, I am one step closer.

Good luck

I haven’t presented, but I’ve been offered the opportunity to attend M/M

 

[PeleHonuaMea]

I've been told some Med schools don't like taking nurses that are too "deeply indoctrinated".

For physicians or adcoms- what particularly about the "nursing mindset" do you find flawed or dislike?

It all depends on how you present yourself to the Adcoms and as long as you dont put anyone else down (nurses, NPs...etc) on your journey as a physician, I'm assuming you will be fine.

But just a little bit of advice from a fellow RN with 10+ years experience: regarding those "old nurses", remember that although some are set in their ways, MOST have 25+ years of experience under their belt. They still deserve alot of our respect. Just like some patients, they might be Mrs. Grumpy Pants at first... but deep deep deep inside of them there's a little care bear hiding there ... you just have to have some patience and figure out a way to appeal to that part of their soul 🙂

 

[Angus Avagadro]

I have had RNs and PAs as med students. I have not run into a Nursing Mindset. All those students were easy to teach and had a good deal of intellectual curiosity. I think you might be a little sensitive to what you might have heard. Could what you describe actually, exist? I'm sure some RNs have been difficult students in the past quoting past experiences when they challenge instructors. The only group i have had some problems with are former paramedics, which is understandable since they have had practice protocols drilled into their head. Old dogma is hard to shake
I personally dont believe ADcoms would discriminate over being non RN. Good luck and best wishes

 

[Psai]

Nursing mindset is following rules and protocols because that's just how things are done. Very little critical thinking involved and a huge disdain for independent thought. You can explain things to them but they won't listen and keep doing things the way they were taught. What you say and what they hear are two very different things.

 

[RNtoMD87]

Nursing mindset is following rules and protocols because that's just how things are done. Very little critical thinking involved and a huge disdain for independent thought. You can explain things to them but they won't listen and keep doing things the way they were taught. What you say and what they hear are two very different things.

I’m just not sure about that. Critical thinking is a big part of my job. It’s not just following doctors orders. There are a lot of nursing interventions outside of medication that we have to make a call on.

Also, I’ll give you an example I get a lot. I have new nurses come to more experienced and they say

New student-“should I give this patients metoprolol?”

Experienced nurse- “Well what’s the dose?”
“Oh 25”
“what’s the pulse and blood pressure?”
“98/57 and 74”
“Look back in the chart. What do they usually run? Has it been that low before? Did the nurse give the dose? If so did they tolerate it well?”

There’s usually not an order to “give if BP is > 100/60 and pulse > 60. Also, as a new nurse I held BP meds for under those parameters (not critically thinking just doing what I was taught in nursing school) and had doctors chew me out for not giving it anyway. And doctors don’t want to be called in the middle of the night every time a patients BP is slightly under those parameters. New nurses drive the doctors up the wall. I can’t tell you how many times I hear a brand new nurse “Hi this is so and so, I’m calling because BP is 98/55...” and immediately I hear the butthurt in their voices. And I’m just thinking “I wish you would’ve asked me first....”

There is actually a lot of critical thinking as a nurse. I’m not saying it’s the same level as a physician, but compared to say a CNA, scribe, etc I think it’s a pretty big part of the job.

 

[Matthew9Thirtyfive]

I’m just not sure about that. Critical thinking is a big part of my job. It’s not just following doctors orders. There are a lot of nursing interventions outside of medication that we have to make a call on.

Also, I’ll give you an example I get a lot. I have new nurses come to more experienced and they say

New student-“should I give this patients metoprolol?”

Experienced nurse- “Well what’s the dose?”
“Oh 25”
“what’s the pulse and blood pressure?”
“98/57 and 74”
“Look back in the chart. What do they usually run? Has it been that low before? Did the nurse give the dose? If so did they tolerate it well?”

There’s usually not an order to “give if BP is > 100/60 and pulse > 60. Also, as a new nurse I held BP meds for under those parameters (not critically thinking just doing what I was taught in nursing school) and had doctors chew me out for not giving it anyway. And doctors don’t want to be called in the middle of the night every time a patients BP is slightly under those parameters. New nurses drive the doctors up the wall. I can’t tell you how many times I hear a brand new nurse “Hi this is so and so, I’m calling because BP is 98/55...” and immediately I hear the butthurt in their voices. And I’m just thinking “I wish you would’ve asked me first....”

There is actually a lot of critical thinking as a nurse. I’m not saying it’s the same level as a physician, but compared to say a CNA, scribe, etc I think it’s a pretty big part of the job.

Just because it’s a part of your job doesn’t mean people do it. I’ve seen what he’s talking about first hand from nurses and allied health. In my experience, it’s usually from older nurses or brand new nurses. But that’s just my anecdotal experience.

 

[RNtoMD87]

Just because it’s a part of your job doesn’t mean people do it. I’ve seen what he’s talking about first hand from nurses and allied health. In my experience, it’s usually from older nurses or brand new nurses. But that’s just my anecdotal experience.

But that’s in any field. Not just nursing. That’s my point. I think that’s pretty understandable to someone new in any field. Example- I usually call up an attending or older resident (most I have built relationships with), and I might say “hey, pts BG is running high. Can we bump the AM lantus dose from 10 to 15 and see what happens?/ patient is hypoglycemic in the mornings, can we hold PM dose/ bump the dose down and see how they do? /BP is running low and I have to hold it often, can we bump metoprolol PO down from 50 to 25?/ etc?”

And they usually just say “yeah do it.” Honestly the NPs are the ones who ask me a million questions about the patient.

But the other day I had a guy, going home the next day. Wasn’t diabetic but they had him on Q4 Accucheks. For the last week he had run 90-110 for every single one. He’s tired of getting stuck constantly so I call to get it changed to ACHS and hear an unfamiliar voice and she says really unsuredly sounding “uhhhmmm let’s just keep doing it like we have been just in case....” so I said “oh? Okay... thanks then”

About 15 minutes later she calls and says “Dr. White (name changed. 3 year ENT resident I work with often and talk to outside of work) said that’s fine! You can make it whatever you want to he says!”

Lack of critical thinking. But, when you’re new, you tend to think in more concrete fashion until you get comfortable, then you get better at abstractly thinking outside the box.

I’ve seen it in every area I’ve learned anything in. Martial arts, the military, marksmanship, police work, nursing, everything.

 

[PeleHonuaMea]

Nursing mindset is following rules and protocols because that's just how things are done. Very little critical thinking involved and a huge disdain for independent thought. You can explain things to them but they won't listen and keep doing things the way they were taught. What you say and what they hear are two very different things.

Not sure about the "disdain for independent thought" and "very little critical thinking"... have you met any ICU nurses? Or those awesome med-surg and tele nurses with a keen eye for change in pts status?

I respectfully disagree with your view of nurses Psai.

(And OP, i STILL dont understand what "nursing mindset" is, but if it's what Psai is defining then that can be applied to ANY group of people...)

I mean, of course there are some difficult nurses, there are "difficult" people in EVERY profession including MDs. But for the most part, nurses are awesome!

Maybe as a MD, if you took a few seconds to listen to what those nurses are trying to tell you even if they're wrong, then guide and correct them... try not to get so upset because they "dont listen" to you.

Isn't that part of being a physician "leader"?

 

[RNtoMD87]

Not sure about the "disdain for independent thought" and "very little critical thinking"... have you met any ICU nurses? Or those awesome med-surg and tele nurses with a keen eye for change in pts status?

I respectfully disagree with your view of nurses (btw OP, i STILL dont understand what nursing mindset is)... of course there are some difficult nurses (there are "difficult" people in EVERY profession, including MDs), but for the most part, nurses are awesome!

Maybe as a MD, if you took a few seconds to listen to what those nurses are trying to tell you even if they're wrong, then guide and correct them... try not to get so upset because they "dont listen" to you.

Isn't that part of being a physician "leader"?

That’s what I’m trying to figure out too. “The nursing mindset”

But one person did have a pretty good point. That we draw conclusions in order to quickly respond to a deteriorating patient, that are usually appropriad but do not have the knowledge to know the exception. I thought that was a good point.


But yes Pele I agree. Many experienced nurses on step down and icu have an almost supernatural ability to know when a patients going to go bad. When I was a new nurse, my preceptor several times would go into a patients room, and the patient was seemingly fine, and they couldn’t even put a finger on it. But they would say “keep a close eye on him. Somethings just not right” and on several occasions they were right.

 

[PeleHonuaMea]

That’s what I’m trying to figure out too. “The nursing mindset”

But one person did have a pretty good point. That we draw conclusions in order to quickly respond to a deteriorating patient, that are usually appropriad but do not have the knowledge to know the exception. I thought that was a good point.


But yes Pele I agree. Many experienced nurses on step down and icu have an almost supernatural ability to know when a patients going to go bad. When I was a new nurse, my preceptor several times would go into a patients room, and the patient was seemingly fine, and they couldn’t even put a finger on it. But they would say “keep a close eye on him. Somethings just not right” and on several occasions they were right.

Bruh, I have met my share of nurses that I just wonder (when I get home) how they even passed the nursing boards . And then there are the superstar nurses who can predict the future... or at least the next RRT!

I find I can learn from both types: what to do and what NOT to do as a nurse 😉

Btw, good luck with your applications and dont look at your experience(s) of being a RN as a bad thing. Just wear it with pride, keep an open mind, and stay humble. You will get plenty interviews!

 

[RNtoMD87]

Bruh, I have met my share of nurses that I just wonder (when I get home) how they even passed the nursing boards . And then there are the superstar nurses who can predict the future... or at least the next RRT!

I find I can learn from both types: what to do and what NOT to do as a nurse 😉

Btw, good luck with your applications and dont look at your experience(s) of being a RN as a bad thing. Just wear it with pride, keep an open mind, and stay humble. You will get plenty interviews!

Oh for sure. That’s any job though. You can’t look at individuals and base the job off of that. I’ve had CNAs with 30 years experience that I thought of as almost an LPN, but I also had some wipe patients faces and genitals with bleach wipes...

 

[deleted480308]

I’m just not sure about that. Critical thinking is a big part of my job. It’s not just following doctors orders. There are a lot of nursing interventions outside of medication that we have to make a call on.

Also, I’ll give you an example I get a lot. I have new nurses come to more experienced and they say

New student-“should I give this patients metoprolol?”

Experienced nurse- “Well what’s the dose?”
“Oh 25”
“what’s the pulse and blood pressure?”
“98/57 and 74”
“Look back in the chart. What do they usually run? Has it been that low before? Did the nurse give the dose? If so did they tolerate it well?”

There’s usually not an order to “give if BP is > 100/60 and pulse > 60. Also, as a new nurse I held BP meds for under those parameters (not critically thinking just doing what I was taught in nursing school) and had doctors chew me out for not giving it anyway. And doctors don’t want to be called in the middle of the night every time a patients BP is slightly under those parameters. New nurses drive the doctors up the wall. I can’t tell you how many times I hear a brand new nurse “Hi this is so and so, I’m calling because BP is 98/55...” and immediately I hear the butthurt in their voices. And I’m just thinking “I wish you would’ve asked me first....”

There is actually a lot of critical thinking as a nurse. I’m not saying it’s the same level as a physician, but compared to say a CNA, scribe, etc I think it’s a pretty big part of the job.

If a prescribed med is going to be skipped the doc needs to be notified unless they have told you it’s fine to skip meds without telling them

 

[RNtoMD87]

If a prescribed med is going to be skipped the doc needs to be notified unless they have told you it’s fine to skip meds without telling them

Right, if I don’t know a physican I wouldn’t. Most of them I have a friendly working relationship with, and some an outside of work relationship with, and there’s also a lot of critical thinking behind it. Do they have a cerebral bleed? Im not going to want their systolic get over say 140 without calling the physician and seeing if I can get something for them. Another patient with no other issues, I wouldn’t be so worried.

Proper nursing care has a good bit of critical thinking involved. A physician isn’t a psychic and cannot foresee everything that will happen, and if a nurse doesn’t use critical thinking and nursing judgement, harm will come to the patient.

I think some of the med students here have a lack of understanding about nursing. It is far from “just following orders”.

 

[deleted480308]

Right, if I don’t know a physican I wouldn’t. Most of them I have a friendly working relationship with, and some an outside of work relationship with, and there’s also a lot of critical thinking behind it. Do they have a cerebral bleed? Im not going to want their get over say 140 without calling the physician and seeing if I can get something for them. Another patient with no other issues, I wouldn’t be so worried.

Proper nursing care has a good bit of critical thinking involved. A physician isn’t a psychic and cannot foresee everything that will happen, and if a nurse doesn’t use critical thinking and nursing judgement, harm will come to the patient.

The point is that telling a story about changing meds without discussing the situation with the doctor responsible is creeping up on a negative example of nursing behavior that we have seen some examples of......It’s also negative for a doc to get mad at you on the phone for calling about a legitimate concern so I need to acknowledge that

But changing meds without doctor notification isn’t good teamwork or good care. Paying attention to the situation and catching a potential bad outcome to something and notifying the doctor about the concern with a suggested change in plan? Great nurse with good care

If you tell a story about holding meds on an interview, it should be a story that includes notifying the doctor you wanted to hold the meds

 

[RNtoMD87]

The point is that telling a story about changing meds without discussing the situation with the doctor responsible is creeping up on a negative example of nursing behavior that we have seen some examples of......It’s also negative for a doc to get mad at you on the phone for calling about a legitimate concern so I need to acknowledge that

But changing meds without doctor notification isn’t good teamwork or good care. Paying attention to the situation and catching a potential bad outcome to something and notifying the doctor about the concern with a suggested change in plan? Great nurse with good care

If you tell a story about holding meds on an interview, it should be a story that includes notifying the doctor you wanted to hold the meds

Well thanks for the advice. Yes it’s pretty usual for doctors to get mad about us calling to hold a med, as well as many other things. I’ve always documented it as “held for BP at unsafe level of so and so and pulse (if applicable)” in epic so I at least acknowledged that it wasn’t given. Usually I inform the doctor because if I’m having to hold it, the dose is probably too high. Sometimes if it wasnt happening often I just held it, but I’ll make sure to wake them up every time. I ain’t scurred.

As a nurse it’s kind of damned it if you damned if you don’t.

“Don’t you know you should hold a blood pressure med for a pressure that low? Why the hell did you have to wake me up?!”

“You’re not a doctor! You can’t make that call!”

 

[deleted480308]

Well thanks for the advice. Yes it’s pretty usual for doctors to get mad about us calling to hold a med, as well as many other things. I’ve always documented it as “held for BP at unsafe level of so and so and pulse (if applicable)” in epic so I at least acknowledged that it wasn’t given. Usually I inform the doctor because if I’m having to hold it, the dose is probably too high. Sometimes if it wasnt happening often I just held it, but I’ll make sure to wake them up every time. I ain’t scurred.

As a nurse it’s kind of damned it if you damned if you don’t.

“Don’t you know you should hold a blood pressure med for a pressure that low? Why the hell did you have to wake me up?!”

“You’re not a doctor! You can’t make that call!”

Doctors getting pissed about phone calls need to write better standing orders or not cash that call paycheck

 

[sunshinefl]

Well thanks for the advice. Yes it’s pretty usual for doctors to get mad about us calling to hold a med, as well as many other things. I’ve always documented it as “held for BP at unsafe level of so and so and pulse (if applicable)” in epic so I at least acknowledged that it wasn’t given. Usually I inform the doctor because if I’m having to hold it, the dose is probably too high. Sometimes if it wasnt happening often I just held it, but I’ll make sure to wake them up every time. I ain’t scurred.

As a nurse it’s kind of damned it if you damned if you don’t.

“Don’t you know you should hold a blood pressure med for a pressure that low? Why the hell did you have to wake me up?!”

“You’re not a doctor! You can’t make that call!”

This is why I like working with 1-2 specific doctors that I know their lines as I do in prison healthcare. I know what things I can manage and then write them a note about/tell them when they come in/schedule for follow up to see them and what things they want to be woken up for in the middle of the night. I generally try to not call from 11pm-5am if I can avoid it. Sometimes that means collecting a few items that come up over the shift to call about in the morning (maybe clarify/extend med orders for 5:30am, diet orders for breakfast at 5:30am, etc). I have never been yelled at for either. Other nurses at my jobs haven’t sorted out those judgement calls and get yelled at in one direction and knee jerk to the other extreme.

Example: 2am rusty bunk laceration? Fine to give tDap without calling. They’ll sign off on order when they come in.

Abscess with systemic symptoms at 3am? Call. Don’t just start “prescribing” antibiotics.

But other nurses would do the opposite and then not understand what the problem is.

 

[RNtoMD87]

This is why I like working with 1-2 specific doctors that I know their lines as I do in prison healthcare. I know what things I can manage and then write them a note about/tell them when they come in/schedule for follow up to see them and what things they want to be woken up for in the middle of the night. I generally try to not call from 11pm-5am if I can avoid it. Sometimes that means collecting a few items that come up over the shift to call about in the morning (maybe clarify/extend med orders for 5:30am, diet orders for breakfast at 5:30am, etc). I have never been yelled at for either. Other nurses at my jobs haven’t sorted out those judgement calls and get yelled at in one direction and knee jerk to the other extreme.

Example: 2am rusty bunk laceration? Fine to give tDap without calling. They’ll sign off on order when they come in.

Abscess with systemic symptoms at 3am? Call. Don’t just start “prescribing” antibiotics.

But other nurses would do the opposite and then not understand what the problem is.

Yeah, I’ve kind of gotten the intuition to know when I need to call and when it can wait. Usually it can wait until they make rounds at 530 am, and come ask what’s up with the patient.

 

[RNthenDoc]

There’s always people like Psai (who goes out of his way to crap on nurses with every post he makes) who have some inferiority complex/bitterness towards nursing, and it’s best to just keep your head down and get through the process. I’ve worked with quite a few nurse-turned-doctors, and let’s just say they have a little extra insight that likely cuts down on the amount of pages they get.

I appreciate the seasoned perspective of Gonnif; that’s as close to an expert as we are going to get.

I certainly faced some negativity from coming from a nursing background (including from a Dean), but in the end the positives outweigh the negatives. There will always be haters, but that’s because they don’t have a 65k/year safety net if they take some time off or decide medicine isn’t for them. 😉

 

[RNtoMD87]

There’s always people like Psai (who goes out of his way to crap on nurses with every post he makes) who have some inferiority complex/bitterness towards nursing, and it’s best to just keep your head down and get through the process. I’ve worked with quite a few nurse-turned-doctors, and let’s just say they have a little extra insight that likely cuts down on the amount of pages they get.

I appreciate the seasoned perspective of Gonnif; that’s as close to an expert as we are going to get.

I certainly faced some negativity from coming from a nursing background (including from a Dean), but in the end the positives outweigh the negatives. There will always be haters, but that’s because they don’t have a 65k/year safety net if they take some time off or decide medicine isn’t for them. 😉

I’m really glad I cleared all this up that rushing isn’t necessary. Would be nice to go do some travel nursing and put serious cash in the bank to alleviate the stress of loans. Or just go back to making 110k a year before playing check the boxes.

 

[RNthenDoc]

I’m really glad I cleared all this up that rushing isn’t necessary. Would be nice to go do some travel nursing and put serious cash in the bank to alleviate the stress of loans.

Absolutely worth it, IMHO. Loans are roughly 7% interest, so imagine an investment with a guaranteed 7% return.

The problem is weighing it out with money lost as a practicing physician on the back end, but everyone is different and everyone has different feelings about massive debt.

 

[deleted480308]

I’m really glad I cleared all this up that rushing isn’t necessary. Would be nice to go do some travel nursing and put serious cash in the bank to alleviate the stress of loans. Or just go back to making 110k a year before playing check the boxes.

I’ll point out you simply won’t make as much travel nursing to save money in a year as you would in that same time frame as a doctor.

If you need the time for your app, that’s fine but it’s not angood financial plan

 

[RNtoMD87]

I’ll point out you simply won’t make as much travel nursing to save money in a year as you would in that same time frame as a doctor.

If you need the time for your app, that’s fine but it’s not angood financial plan

That would be the summers in between semesters since apparently summer is a useless time academically for premeds. Was annoyed that even though I have a measly 28 hours left, it’s going to drag out so long, but oh well.


Some strikes coming up in California. $8,000 a week for 8 weeks sounds nice looking at the debt I’m going to have. Thank god for Union states