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miamidc

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Anesthesia has already been hit and hit hard by nurse practitioners. The downside has been factored in. The bad news is for OB/GYN, Primary Care, EMed, etc,etc. However, this whole Nurses saying they are Doctors is BS, might as well have PAs complete a doctorate in the assisstance of physicians, please. Anyways get ready to cringe reading this!



Doctor shortage? 28 states may expand nurses' role
CHICAGO – A nurse may soon be your doctor. With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor's watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called "Doctor."

For years, nurse practitioners have been playing a bigger role in the nation's health care, especially in regions with few doctors. With 32 million more Americans gaining health insurance within a few years, the health care overhaul is putting more money into nurse-managed clinics.

Those newly insured patients will be looking for doctors and may find nurses instead.

The medical establishment is fighting to protect turf. In some statehouses, doctors have shown up in white coats to testify against nurse practitioner bills. The American Medical Association, which supported the national health care overhaul, says a doctor shortage is no reason to put nurses in charge and endanger patients.

Nurse practitioners argue there's no danger. They say they're highly trained and as skilled as doctors at diagnosing illness during office visits. They know when to refer the sickest patients to doctor specialists. Plus, they spend more time with patients and charge less.

"We're constantly having to prove ourselves," said Chicago nurse practitioner Amanda Cockrell, 32, who tells patients she's just like a doctor "except for the pay."

On top of four years in nursing school, Cockrell spent another three years in a nurse practitioner program, much of it working with patients. Doctors generally spend four years in undergraduate school, four years in medical school and an additional three in primary care residency training.

Medicare, which sets the pace for payments by private insurance, pays nurse practitioners 85 percent of what it pays doctors. An office visit for a Medicare patient in Chicago, for example, pays a doctor about $70 and a nurse practitioner about $60.

The health care overhaul law gave nurse midwives, a type of advanced practice nurse, a Medicare raise to 100 percent of what obstetrician-gynecologists make — and that may be just the beginning.

States regulate nurse practitioners and laws vary on what they are permitted to do:

• In Florida and Alabama, for instance, nurse practitioners are barred from prescribing controlled substances.

• In Washington, nurse practitioners can recommend medical marijuana to their patients when a new law takes effect in June.

• In Montana, nurse practitioners don't need a doctor involved with their practice in any way.

• Many other states put doctors in charge of nurse practitioners or require collaborative agreements signed by a doctor.

• In some states, nurse practitioners with a doctorate in nursing practice can't use the title "Dr." Most states allow it.

The AMA argues the title "Dr." creates confusion. Nurse practitioners say patients aren't confused by veterinarians calling themselves "Dr." Or chiropractors. Or dentists. So why, they ask, would patients be confused by a nurse using the title?

The feud over "Dr." is no joke. By 2015, most new nurse practitioners will hold doctorates, or a DNP, in nursing practice, according to a goal set by nursing educators. By then, the doctorate will be the standard for all graduating nurse practitioners, said Polly Bednash, executive director of the American Association of Colleges of Nursing.

Many with the title use it with pride.

"I don't think patients are ever confused. People are not stupid," said Linda Roemer, a nurse practitioner in Sedona, Ariz., who uses "Dr. Roemer" as part of her e-mail address.

What's the evidence on the quality of care given by nurse practitioners?

The best U.S. study comparing nurse practitioners and doctors randomly assigned more than 1,300 patients to either a nurse practitioner or a doctor. After six months, overall health, diabetes tests, asthma tests and use of medical services like specialists were essentially the same in the two groups.

"The argument that patients' health is put in jeopardy by nurse practitioners? There's no evidence to support that," said Jack Needleman, a health policy expert at the University of California Los Angeles School of Public Health.

Other studies have shown that nurse practitioners are better at listening to patients, Needleman said. And they make good decisions about when to refer patients to doctors for more specialized care.

The nonpartisan Macy Foundation, a New York-based charity that focuses on the education of health professionals, recently called for nurse practitioners to be among the leaders of primary care teams. The foundation also urged the removal of state and federal barriers preventing nurse practitioners from providing primary care.

The American Medical Association is fighting proposals in about 28 states that are considering steps to expand what nurse practitioners can do.

"A shortage of one type of professional is not a reason to change the standards of medical care," said AMA president-elect Dr. Cecil Wilson. "We need to train more physicians."

In Florida, a bill to allow nurse practitioners to prescribe controlled substances is stalled in committee.

One patient, Karen Reid of Balrico, Fla., said she was left in pain over a holiday weekend because her nurse practitioner couldn't prescribe a powerful enough medication and the doctor couldn't be found. Dying hospice patients have been denied morphine in their final hours because a doctor couldn't be reached in the middle of the night, nurses told The Associated Press.

Massachusetts, the model for the federal health care overhaul, passed its law in 2006 expanding health insurance to nearly all residents and creating long waits for primary care. In 2008, the state passed a law requiring health plans to recognize and reimburse nurse practitioners as primary care providers.

That means insurers now list nurse practitioners along with doctors as primary care choices, said Mary Ann Hart, a nurse and public policy expert at Regis College in Weston, Mass. "That greatly opens up the supply of primary care providers," Hart said.

But it hasn't helped much so far. A study last year by the Massachusetts Medical Society found the percentage of primary care practices closed to new patients was higher than ever. And despite the swelling demand, the medical society still believes nurse practitioners should be under doctor supervision.

The group supports more training and incentives for primary care doctors and a team approach to medicine that includes nurse practitioners and physician assistants, whose training is comparable.

"We do not believe, however, that nurse practitioners have the qualifications to be independent primary care practitioners," said Dr. Mario Motta, president of the state medical society.

The new U.S. health care law expands the role of nurses with:

• $50 million to nurse-managed health clinics that offer primary care to low-income patients.

• $50 million annually from 2012-15 for hospitals to train nurses with advanced degrees to care for Medicare patients.

• 10 percent bonuses from Medicare from 2011-16 to primary care providers, including nurse practitioners, who work in areas where doctors are scarce.

• A boost in the Medicare reimbursement rate for certified nurse midwives to bring their pay to the same level as a doctor's.

The American Nurses Association hopes the 100 percent Medicare parity for nurse midwives will be extended to other nurses with advanced degrees.

"We know we need to get to 100 percent for everybody. This is a crack in the door," said Michelle Artz of ANA. "We're hopeful this sets the tone."

In Chicago, only a few patients balk at seeing a nurse practitioner instead of a doctor, Cockrell said. She gladly sends those patients to her doctor partners.

She believes patients get real advantages by letting her manage their care. Nurse practitioners' uphill battle for respect makes them precise, accurate and careful, she said. She schedules 40 minutes for a physical exam; the doctors in her office book 30 minutes for same appointment.

Joseline Nunez, 26, is a patient of Cockrell's and happy with her care.

"I feel that we get more time with the nurse practitioner," Nunez said. "The doctor always seems to be rushing off somewhere."

___

On the Net:

American Nurses Association, http://www.nursingworld.org/
 

Surfer

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Nurses want to steal the low-lying fruit. They're more than happy to refer off the complicated cases because there's no money to be made on complex medical issues, especially in primary care.

DNP is a joke. I will never call a nurse a doctor.
 

SleepIsGood

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Again...the public should be aware of this:

Nurses 'refer' out or ask for help when things get complicated and dont tell the patient often they are doing that. It's hard to show differences when doctors willingly bail out nurses. IF a CRNA botches a procedure or mismanages a case, a physicians intervenes and corrects the situation, thus 'hiding' or making invisible the nurse's mistakes.

Also,I think this sort of thing needs to be EXPOSED to the public more. When talking to my friends outside of medicine about DNPs and CRNAs they are completely taken back. They can't even believe it. They didnt even know such a thing is happening. They automatically assumed everyone with a white coat and such is a physician.

So it's on YOU. EVERY YOUNG PHYSICIAN or MED STUDENT to talk to your patients and bring awareness. I do it when I preop/post op patients ALL THE TIME. I do it in the pain clinic.

It's your LIFE. It's also the patient's right to know. When there's transparency and the patient knows there's a difference, they will CERTAINLY pick a physician over a nurse.
 

Surfer

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its unbelievable how society is becoming so spineless. nurses are claiming equivalence to PHYSICIANS!! it would be downright hilarious if it weren't true! its all just symptom of this pansy society we live in where everybody is told they're winners and nobody is "better" than anybody else. i'm not saying i'm better because i'm a physician, but i am saying my ability to diagnose and treat disease is better. america is in for some big problems ahead because we're awash in this sea of mediocrity and surrounded by a fog of "moral equivalence."

and the quotes they use in that story are laughable. "i like nurses because they spend more time with me. my nurse is the same as a dr except they spend more time with me and cost less." then in the same paragraph they go on to say how nurses should make the same as doctors. what a joke! how's that for talking out of both sides of your mouth? They have several quotes where patients complain that their doctor seemed to be rushed. People are totally clueless, which is why long-term we're F-ed!
 

karizma098

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nurse practitioners are going to take over family practice. i know this is a terrible thing to say, but i just don't think there's much we can do to save that field, within the next 10-15 years it's going to be run by nurses.

does anyone live in the midwest? walgreens pharmacies have 'take care clinics' where you can basically walk in and get any treatment an FP does done by a nurse.

while we still have power we need to fight to push CRNA's out of anesthesia, keep midwives and ob nurses from too much involvement in ob cases, and keep ER nurse practitioners underneath physician supervision.

that article is a freaking joke. nurse propoganda in action at it's best.

the fight to be called 'doctor' is nothing more than an effort to blur the lines between physician and nurse.
"oh yes, he/she's a physician and i'm a nurse practitioner, but we're both doctors and provide equivalent care".

trust me, it won't be long before we start hearing this from our dr. nurse 'colleagues'.

as a new generation of physician we need to pick up the slack - where our forefathers couldn't deliver, we need to. Donate to the ASA, and for gods sake, we need some better leadership than the AMA.

for these nurses, this has little to do with patient care, and a lot more to do with $$.
 

karizma098

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automatically assumed everyone with a white coat and such is a physician.

So it's on YOU. EVERY YOUNG PHYSICIAN or MED STUDENT to talk to your patients and bring awareness. I do it when I preop/post op patients ALL THE TIME. I do it in the pain clinic.

It's your LIFE. It's also the patient's right to know. When there's transparency and the patient knows there's a difference, they will CERTAINLY pick a physician over a nurse.
:thumbup:
 

Southpaw

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Physicians are the problem. Every single angry nurse out there who wants more power will at some point in their training, learn from a physician. I can't change the mindset of a bitter, militant nurse, but I can't certainly decide I'll never have a hand in training someone lesser trained who wants the authority I've earned through working harder and staying in school longer.
 

karizma098

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Physicians are the problem. Every single angry nurse out there who wants more power will at some point in their training, learn from a physician. I can't change the mindset of a bitter, militant nurse, but I can't certainly decide I'll never have a hand in training someone lesser trained who wants the authority I've earned through working harder and staying in school longer.
I agree 100%.

as physicians / future physicians (especially anesthesiologists), we need to stop allowing our colleagues to teach midlevels how to practice medicine -

Do we see surgeons teaching surgical nurses how to perform a hernia repair? no. they have to work crazy hours, but they aren't passing their work onto someone else.

Could a nurse probably perform an average hernia repair with practice and instruction from a physician (with a few years of clinical training )? most likely....but that doesn't make it the right thing to do.

the same stands for anesthesia, FP, and OB. we need to stop letting midlevels encroach on our cases and procedures.

Also, our generation of MD's and DO's needs to take a strong stance against midlevel clinical advancement - they are here to ASSIST physicians, not practice medicine alongside them.

a paralegal may gain extensive knowledge of how a particular aspect of a legal firm works but they are not called lawyers. A talented mechanic can put a car back together well - but they do not have the knowledge of an engineer. In these trades, no one sees these jobs as 'equivalent' to each other. why should nurses be seen equivalent to an FP/anesthesiologist/ob?
we've been losing this battle for decades, it's time to turn it around.

our society is too mushy and wussy to let a nurse know that they are NOT equivalent in education and experience to a physician, and never will be, unless they go to medical school. We, as physicians need to stand up for this statement throughout our career.
 

cfdavid

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Again...the public should be aware of this:

Nurses 'refer' out or ask for help when things get complicated and dont tell the patient often they are doing that. It's hard to show differences when doctors willingly bail out nurses. IF a CRNA botches a procedure or mismanages a case, a physicians intervenes and corrects the situation, thus 'hiding' or making invisible the nurse's mistakes.

Also,I think this sort of thing needs to be EXPOSED to the public more. When talking to my friends outside of medicine about DNPs and CRNAs they are completely taken back. They can't even believe it. They didnt even know such a thing is happening. They automatically assumed everyone with a white coat and such is a physician.

So it's on YOU. EVERY YOUNG PHYSICIAN or MED STUDENT to talk to your patients and bring awareness. I do it when I preop/post op patients ALL THE TIME. I do it in the pain clinic.

It's your LIFE. It's also the patient's right to know. When there's transparency and the patient knows there's a difference, they will CERTAINLY pick a physician over a nurse.
Sleep, I totally agree. The public is, for the most part, completely left in the dark. And, in general, from the people I've spoke with, they do NOT agree with this massive encroachment of mid-levels into THEIR CARE.....

But, we're a nation notorious for not investing in our people (i.e. training more docs is far costlier than importing from nations that do the heavy lifting and then lose intellectual capital (thus any societal investment) to the US, and this is NOT a slam against FMGs at all, but rather a critique of the US's absolute unwillingness to make long term investments in many areas of "infrastructure" (which includes medical education).

We're also a nation that will continue to implement desperate solutions to mounting fiscal crises nationwide.... It is what it is. All we can do is hunker down and become more active.

Regarding white coats, the UNIT CLERK in the MICU where I'm rotating likes to wear one......:laugh: (the long version too).... Oh boy.

cf
 

Ender

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Sleep, I totally agree. The public is, for the most part, completely left in the dark. And, in general, from the people I've spoke with, they do NOT agree with this massive encroachment of mid-levels into THEIR CARE.....

But, we're a nation notorious for not investing in our people (i.e. training more docs is far costlier than importing from nations that do the heavy lifting and then lose intellectual capital (thus any societal investment) to the US, and this is NOT a slam against FMGs at all, but rather a critique of the US's absolute unwillingness to make long term investments in many areas of "infrastructure" (which includes medical education).

We're also a nation that will continue to implement desperate solutions to mounting fiscal crises nationwide.... It is what it is. All we can do is hunker down and become more active.

Regarding white coats, the UNIT CLERK in the MICU where I'm rotating likes to wear one......:laugh: (the long version too).... Oh boy.

cf
To make a strong argument as physicians we need to be logical and point out he fallacy in the statements made by midlevel nursing organizations. You cannot just say you are better because you are a physician and they are not.

Example:

Questions: Are Nurse Practitioners as well trained as physicians?

Facts: Nurse practitioners spend anywhere from 5 to 6 years to complete their training

4 years for BSN
2 year masters degree in Family/Midwife/Peds, etc
=6 years

or

2 years for associate degree
1 year accelerated bridge to BSN
2 year masters degree in Family/Midwife/Peds, etc
=5 years

It only takes longer if the slow down the process, because they are working as nurses during their "advanced training."

Source: http://education-portal.com/how_to_become_a_nurse_practitioner.html

After BSN, almost everything can now be done online:
http://onlinenursepractitionerprograms.com/

Facts: Physicians train for at least 11 years.

4 years for Bachelors degree
4 years for medical school
3 years for residency (for primary care only)

How many people with an bachelors degree, mostly earned online, have been accepted to medical school? I do not even have to talk to admissions to get that answer.

Can medical school or residency be done online? NO
To think of such a thing seems completely absurd.

The ANA are calling their training equivalent to yours. They are saying that 5-6 years of nursing training is equal to 11-14 years of medical training.

Does this seem logical?

How many hours do we get of hands on training in residency? NPs do not have residency training. They try to call their clinical time residency. Do we call our clinical time in medical school residency?

Fellow doctors, would you feel comfortable practicing unsupervised medicine without having completed residency?

Fellow doctors, would you feel comfortable practicing medicine without any supervision after only completing 2 years of medical school?

No, of course not. You are much more concerned that someone with be hurt because of your lack of knowledge than you are interested in making a quick buck, which is the opposite of some of our nurse colleagues.

What about the so called "study" that was done comparing outcomes? I would really like to read it, but I already have some major concerns. How about selection bias? The simple fact is that sicker patients will go to a physician and not an NP.

NPs are more expensive than physicians. They see half the patients, order more tests, work half hours, and want to be paid the same as physicians. They will bankrupt our system.

These are some of the facts that must be pointed out when talking to the general public and too our public representatives.

Ender
 
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SleepIsGood

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My dad read the exact article in the local newspaper. This article is getting a lot of play nationally.
 

IN2B8R

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Anesthesia has already been hit and hit hard by nurse practitioners. The downside has been factored in. The bad news is for OB/GYN, Primary Care, EMed, etc,etc. However, this whole Nurses saying they are Doctors is BS, might as well have PAs complete a doctorate in the assisstance of physicians, please. Anyways get ready to cringe reading this!



Doctor shortage? 28 states may expand nurses' role
CHICAGO – A nurse may soon be your doctor. With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor's watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called "Doctor."

For years, nurse practitioners have been playing a bigger role in the nation's health care, especially in regions with few doctors. With 32 million more Americans gaining health insurance within a few years, the health care overhaul is putting more money into nurse-managed clinics.

Those newly insured patients will be looking for doctors and may find nurses instead.

The medical establishment is fighting to protect turf. In some statehouses, doctors have shown up in white coats to testify against nurse practitioner bills. The American Medical Association, which supported the national health care overhaul, says a doctor shortage is no reason to put nurses in charge and endanger patients.

Nurse practitioners argue there's no danger. They say they're highly trained and as skilled as doctors at diagnosing illness during office visits. They know when to refer the sickest patients to doctor specialists. Plus, they spend more time with patients and charge less.

"We're constantly having to prove ourselves," said Chicago nurse practitioner Amanda Cockrell, 32, who tells patients she's just like a doctor "except for the pay."

On top of four years in nursing school, Cockrell spent another three years in a nurse practitioner program, much of it working with patients. Doctors generally spend four years in undergraduate school, four years in medical school and an additional three in primary care residency training.

Medicare, which sets the pace for payments by private insurance, pays nurse practitioners 85 percent of what it pays doctors. An office visit for a Medicare patient in Chicago, for example, pays a doctor about $70 and a nurse practitioner about $60.

The health care overhaul law gave nurse midwives, a type of advanced practice nurse, a Medicare raise to 100 percent of what obstetrician-gynecologists make — and that may be just the beginning.

States regulate nurse practitioners and laws vary on what they are permitted to do:

• In Florida and Alabama, for instance, nurse practitioners are barred from prescribing controlled substances.

• In Washington, nurse practitioners can recommend medical marijuana to their patients when a new law takes effect in June.

• In Montana, nurse practitioners don't need a doctor involved with their practice in any way.

• Many other states put doctors in charge of nurse practitioners or require collaborative agreements signed by a doctor.

• In some states, nurse practitioners with a doctorate in nursing practice can't use the title "Dr." Most states allow it.

The AMA argues the title "Dr." creates confusion. Nurse practitioners say patients aren't confused by veterinarians calling themselves "Dr." Or chiropractors. Or dentists. So why, they ask, would patients be confused by a nurse using the title?

The feud over "Dr." is no joke. By 2015, most new nurse practitioners will hold doctorates, or a DNP, in nursing practice, according to a goal set by nursing educators. By then, the doctorate will be the standard for all graduating nurse practitioners, said Polly Bednash, executive director of the American Association of Colleges of Nursing.

Many with the title use it with pride.

"I don't think patients are ever confused. People are not stupid," said Linda Roemer, a nurse practitioner in Sedona, Ariz., who uses "Dr. Roemer" as part of her e-mail address.

What's the evidence on the quality of care given by nurse practitioners?

The best U.S. study comparing nurse practitioners and doctors randomly assigned more than 1,300 patients to either a nurse practitioner or a doctor. After six months, overall health, diabetes tests, asthma tests and use of medical services like specialists were essentially the same in the two groups.

"The argument that patients' health is put in jeopardy by nurse practitioners? There's no evidence to support that," said Jack Needleman, a health policy expert at the University of California Los Angeles School of Public Health.

Other studies have shown that nurse practitioners are better at listening to patients, Needleman said. And they make good decisions about when to refer patients to doctors for more specialized care.

The nonpartisan Macy Foundation, a New York-based charity that focuses on the education of health professionals, recently called for nurse practitioners to be among the leaders of primary care teams. The foundation also urged the removal of state and federal barriers preventing nurse practitioners from providing primary care.

The American Medical Association is fighting proposals in about 28 states that are considering steps to expand what nurse practitioners can do.

"A shortage of one type of professional is not a reason to change the standards of medical care," said AMA president-elect Dr. Cecil Wilson. "We need to train more physicians."

In Florida, a bill to allow nurse practitioners to prescribe controlled substances is stalled in committee.

One patient, Karen Reid of Balrico, Fla., said she was left in pain over a holiday weekend because her nurse practitioner couldn't prescribe a powerful enough medication and the doctor couldn't be found. Dying hospice patients have been denied morphine in their final hours because a doctor couldn't be reached in the middle of the night, nurses told The Associated Press.

Massachusetts, the model for the federal health care overhaul, passed its law in 2006 expanding health insurance to nearly all residents and creating long waits for primary care. In 2008, the state passed a law requiring health plans to recognize and reimburse nurse practitioners as primary care providers.

That means insurers now list nurse practitioners along with doctors as primary care choices, said Mary Ann Hart, a nurse and public policy expert at Regis College in Weston, Mass. "That greatly opens up the supply of primary care providers," Hart said.

But it hasn't helped much so far. A study last year by the Massachusetts Medical Society found the percentage of primary care practices closed to new patients was higher than ever. And despite the swelling demand, the medical society still believes nurse practitioners should be under doctor supervision.

The group supports more training and incentives for primary care doctors and a team approach to medicine that includes nurse practitioners and physician assistants, whose training is comparable.

"We do not believe, however, that nurse practitioners have the qualifications to be independent primary care practitioners," said Dr. Mario Motta, president of the state medical society.

The new U.S. health care law expands the role of nurses with:

• $50 million to nurse-managed health clinics that offer primary care to low-income patients.

• $50 million annually from 2012-15 for hospitals to train nurses with advanced degrees to care for Medicare patients.

• 10 percent bonuses from Medicare from 2011-16 to primary care providers, including nurse practitioners, who work in areas where doctors are scarce.

• A boost in the Medicare reimbursement rate for certified nurse midwives to bring their pay to the same level as a doctor's.

The American Nurses Association hopes the 100 percent Medicare parity for nurse midwives will be extended to other nurses with advanced degrees.

"We know we need to get to 100 percent for everybody. This is a crack in the door," said Michelle Artz of ANA. "We're hopeful this sets the tone."

In Chicago, only a few patients balk at seeing a nurse practitioner instead of a doctor, Cockrell said. She gladly sends those patients to her doctor partners.

She believes patients get real advantages by letting her manage their care. Nurse practitioners' uphill battle for respect makes them precise, accurate and careful, she said. She schedules 40 minutes for a physical exam; the doctors in her office book 30 minutes for same appointment.

Joseline Nunez, 26, is a patient of Cockrell's and happy with her care.

"I feel that we get more time with the nurse practitioner," Nunez said. "The doctor always seems to be rushing off somewhere."

___

On the Net:

American Nurses Association, http://www.nursingworld.org/
I will be first in line to offer my expert witness opinion against these midlevel, know nothing "practioners.":D
 

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Many of the comments posted after that article (on the MSNBC website) talk about "equivalent" care provided by NPs as MDs. I have no doubt that a well-trained, experienced NP can provide good primary care (abx for sinusitis, DM management, etc.), but these comments are most likely indicative of friendlier healthcare rather than more scientific/producing better outcomes/cutting edge/evidence-based/whatever care since most patients do not know the optimal management of their conditions. And, IMO, this all ties into the PR problem we have as physicians. While we have legitimate arguments as to why an NP should not (and not be allowed to find a way to) do things other than routine care, the public seems to think the basis of our argument is largely driven by greed/concern about losing revenue. I agree that we should educate patients/consumers about the differences in rigor of training between MDs/DOs and NPs, but we would probably fare better if we took a PR friendly approach in doing so.
 

Ender

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Many of the comments posted after that article (on the MSNBC website) talk about "equivalent" care provided by NPs as MDs. I have no doubt that a well-trained, experienced NP can provide good primary care (abx for sinusitis, DM management, etc.), but these comments are most likely indicative of friendlier healthcare rather than more scientific/producing better outcomes/cutting edge/evidence-based/whatever care since most patients do not know the optimal management of their conditions. And, IMO, this all ties into the PR problem we have as physicians. While we have legitimate arguments as to why an NP should not (and not be allowed to find a way to) do things other than routine care, the public seems to think the basis of our argument is largely driven by greed/concern about losing revenue. I agree that we should educate patients/consumers about the differences in rigor of training between MDs/DOs and NPs, but we would probably fare better if we took a PR friendly approach in doing so.
Agreed

Ender
 

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...while we still have power...
Do we?

I am not sure.

However, everything else you say in your posts is true and I wish we could have them read by all U. S. physicians, young and old, and all medical students.

Karizma, you said a great truth when you pointed out that surgeons don't teach their skills to other people. Normally, even other physicians are not allowed to impinge into the surgeons' turf. I cannot picture a surgeon teaching a nurse how to do an operation, not even in the most rudimentary conditions or in the poorest countries of the world. Yet we, anesthesiologists, do it all the time. There is something wrong with us. Maybe we should create a fund for psychiatric help for our profession.

Greetings
 

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This is what they should be getting-- an ass-caning.

 

karizma098

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Maybe we should create a fund for psychiatric help for our profession.

Greetings
haha, that might be the only way to get through to some people.

I wish medical school curriculum included education on topics such as this, i feel like many of my classmates are completely clueless with what they are up against in terms of midlevel encroachment - not only from CRNA's, but from NP's and PA's as well.

it seems like everyone wants to 'play doctor' nowadays....
 

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I wish medical school curriculum included education on topics such as this, i feel like many of my classmates are completely clueless with what they are up against in terms of midlevel encroachment - not only from CRNA's, but from NP's and PA's as well.
.
Actually modern med school teaches the opposite...how no one is more important than anyone else and it's always a "team approach". There is such a push to accept other professions as equals and part of the team. We spent WAY too much time in our school learning how to collaborate with others. And they basically told us the physician is often no longer the leader of that team. Unfortunately I saw examples of this too many times with physicians who just roll over and take it because some nurse has a more aggressive personality. It's easier to just play dead than to fight with Nurse Rached.
 

tncekm

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Put money together--- A LOOOOOT OF MONEY--start an ad campaign, and scare the truth into people. It's simple, and there are enough physicians that an organized, sustained effort can easily be achieved.
 

tncekm

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Actually modern med school teaches the opposite...how no one is more important than anyone else and it's always a "team approach". There is such a push to accept other professions as equals and part of the team. We spent WAY too much time in our school learning how to collaborate with others. And they basically told us the physician is often no longer the leader of that team. Unfortunately I saw examples of this too many times with physicians who just roll over and take it because some nurse has a more aggressive personality. It's easier to just play dead than to fight with Nurse Rached.
Political correctness has LITERALLY turned the world upside down--at least the western world.
 

fakin' the funk

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So it's on YOU. EVERY YOUNG PHYSICIAN or MED STUDENT to talk to your patients and bring awareness. I do it when I preop/post op patients ALL THE TIME. I do it in the pain clinic.
Sleep,

How and when do you bring this up? I'm just having a hard time coming up with a way to make a smooth segue from Past Medical History to The Difference Between The Various White Coat People.
 
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sebsvenmdc

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I think we just need to out-do nurses. First of all, they don't have the M.D., so they come from an inferior stock educationally. If they're so eager to be doctor-wannabes, why don't they take the traditional route of med school? Because they can't get in? Because it takes longer...that's freaking BS, why should they be so special that they are afforded an accelerated avenue into a supposedly equal practice? Secondly, we need to show them and the public why we are physicians. Perhaps this means family medicine disappearing and med students increasing in droves into more specialized healthcare so that really instead of a substitute, these NPs are just filling in a gap. With regard to CRNAs, we have to figure out how to out-do them in the OR. What can or do we do that makes us different from them? As a med student still, I don't have that answer (from my lack of clinical expertise and fund of knowledge about the field overall). There has to be some substantial differences though. I would think that CRNAs have a much less solid understanding of pharmacology, physiology, and pathophysiology. How can we use this skill-set not only to save lives as much as possible, but also to set us apart from the competition. Surely, getting into CRNA programs is not as challenging as med school. They cannot have the same difficulty in entrance exams, board exams, and overall rigor of training. We need to do a better job of not only out-doing them clinically, but also of transferring a theoretical skill-set into the OR in a way that improves safety and performance. If it turns out that our additional expertise and training is so far above the necessary bar/standards, then we're in a bit of a trouble because the CRNAs have a good argument about our redundancy. It surely pisses off all of us that have studied extremely hard to do well in college, taken the MCAT, gone through medical school, done well on boards...then residency...and for what, some impatient prick to do half the training, but claim to be as skilled and adept at the same job?
 

gasaddict54

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I think we just need to out-do nurses. First of all, they don't have the M.D., so they come from an inferior stock educationally. If they're so eager to be doctor-wannabes, why don't they take the traditional route of med school? Because they can't get in? Because it takes longer...that's freaking BS, why should they be so special that they are afforded an accelerated avenue into a supposedly equal practice? Secondly, we need to show them and the public why we are physicians. Perhaps this means family medicine disappearing and med students increasing in droves into more specialized healthcare so that really instead of a substitute, these NPs are just filling in a gap. With regard to CRNAs, we have to figure out how to out-do them in the OR. What can or do we do that makes us different from them? As a med student still, I don't have that answer (from my lack of clinical expertise and fund of knowledge about the field overall). There has to be some substantial differences though. I would think that CRNAs have a much less solid understanding of pharmacology, physiology, and pathophysiology. How can we use this skill-set not only to save lives as much as possible, but also to set us apart from the competition. Surely, getting into CRNA programs is not as challenging as med school. They cannot have the same difficulty in entrance exams, board exams, and overall rigor of training. We need to do a better job of not only out-doing them clinically, but also of transferring a theoretical skill-set into the OR in a way that improves safety and performance. If it turns out that our additional expertise and training is so far above the necessary bar/standards, then we're in a bit of a trouble because the CRNAs have a good argument about our redundancy. It surely pisses off all of us that have studied extremely hard to do well in college, taken the MCAT, gone through medical school, done well on boards...then residency...and for what, some impatient prick to do half the training, but claim to be as skilled and adept at the same job?

It seems that my take is a little different than the avg person on here but here goes. I hear all the time about flooding the market w AAs will somehow ease the pain bc they are easier to control etc. IMO this is insane bc u still are putting more ansesthesia providers ont he market and making the MD less and less as a part of the model of anesthesia. I hear well they are an "assistant". Ha how long you think thats going to go the route of NP and crna? How long will it be before AAs want just as much as CRNAs? uh not very long at all. IMO we need more MDs as we are quickly becoming outnumbered ( strength in # s etc). Here is another one for ya, MDs ( attendings close your eyes) are going to start doing more of their own cases. If you want to show how you are better do the freaking case. Now that we have "heart and neuro crnas" the expertise argument gets even more diluted. One man's opinion.
 

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I practiced with a fellow physician several years back who left medicine to become a catholic priest.

His name was Martin.

He was an amazing individual to know/interact with/work with.

A truly faith driven man, albeit non-judgemental, who during the time I knew him was a practicing physician awaiting God's guidance.

Martin eventually left medicine for the priesthood. He literally gave up everything he had materially, told his girlfriend he was becoming a priest...

at this point you, the reader, is thinking "Jet, what the f u ck?"

Relax.

I continue:


Martin and I were chillin in the doctor's lounge one day. I was intrigued by his commitment....by the message he was receiving....kinda cool s h it.

Martin, amidst our conversation about whatever, recites some important vatican thinghy that says

"THERE IS ONLY ONE TRUTH."

Martin remarked that the passage was self explanatory.

I WANT YOU TO SIT ON THAT STATEMENT FOR A MINUTE.

THERE IS ONLY ONE TRUTH.

WOW.

I'll always remember that conversation with Martin, since the content of said conversation had a major impact on me.

OK OK OK BACK TO THE THREAD

When I see a nursing group politically taking a stance to blur the boundaries between

BEING A PHYSICIAN AND BEING A F U KKING NURSE....AND SAID F U KKING NURSE WANTS TO BE CALLED 'DOCTOR"

it really upsets me.

The term DOCTOR

is reserved for people who went to med school.

Only insecure PhDs demand the DOCTOR title: (true story follows....bald headed, ugly, short, fiftyish dude comes for a lap chole:)

JET: "Hey, Mr Smith? Yeah hi! I'm Dr Jet, one of the anesthesiologists here. I'm gonna put you to sleep for your gall bladder surgery. You're gonna do fine. We are gonna take very good care of you."

A SS H OLE PATIENT WITH NAPOLEONIC COMPLEX: (patient acting very aloof) "Its not mister Smith. Its DOCTOR Smith."

JET: (still in dark) "OH DUDE! Sorry about that, doc. Whatcha practice?"

A SS H OLE PATIENT WITH NAPOLEONIC COMPLEX: "I have a PhD in English."

I tried not to spit my gum out in laughter.

I think I lowered my head and shook it a little.

Back to the thread, Jet....

OK.

"DOCTOR", when used in a way that our society understands, refers to a dude/dudette who went to med school and did a residency. Who practices MEDICINE. Who makes their living being a DOCTOR. The term "DOCTOR" does NOT include nurses with a "doctorate" nursing degree.

You've read this long post.

I want you to remember one thing, and one thing only:

THERE IS ONLY ONE TRUTH.

Like Martin said.

Like the Vatican said.

Anyone who hasnt been to med school who calls themself DOCTOR

does not realize

HOW MUCH THEY ARE LYING TO THEMSELVES. AND TO THE WORLD.

There is only one truth.
 
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rsgillmd

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Sleep,

How and when do you bring this up? I'm just having a hard time coming up with a way to make a smooth segue from Past Medical History to The Difference Between The Various White Coat People.
I don't know what sleep does, but I can tell you what I do. It's the little things.

I do my calls in OB. Some of my colleagues are would rather give more flexibility to the CRNAs than I do so they can sleep at night. A couple of times I've taken over in the morning and I get asked, "Can we pull the epidural in patient X? Y CRNA said he wanted coags back before pulling it." 99% of the time when I see the patient and review the history my answer is, "I wouldn't have ordered the coags anyway. I'll pull it now." I follow this up with, "If you have any doubts, call the attending anesthesiologist and have an attending to attending conversation. You know I'm willing to talk to you any time. I'm sure if approached, my colleagues will feel the same way."

Gradually those incidents have decreased. So I feel I have made my OB colleagues see the difference.

From the patient perspective I just take a couple of extra seconds to help calm patients down, and ask non-medical questions about them -- scared people generally like to talk about themselves because it gives them a sense of control. I make sure that when I introduce myself, I say "Hi Mr A. My name is Dr. rsgillmd. I am the physician that is going to help take care of you during your surgery." Then I follow all of this up during the post-op visit where I try to make it clear that I really care about their anesthetic experience and their recovery.

I'm sure the above doesn't sound like anything special, an it isn't. It's the little things that add together: your body language, your appearance (yes that includes the clean white coat), mentioning your physician status, tone of voice, slowing down the pace of questions, etc. They will remember you, not the CRNA. You helped them with their pain in recovery, not the CRNA. You were the one who easily placed the IV/A-line/Epidural/whatever else when the CRNA was struggling. You were the one that followed up on them after surgery, not the CRNA, etc. So if/when the CRNA vs MD issue becomes a hot topic locally, you should have a loyal following. The change is not going to be overnight -- it is one patient at a time.
 
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hellothane

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congratulations rsgillmd, you have done your job, if more anesthesiologists did their job instead of supervising there would be far fewer questions on the need for anesthesiologists, and these threads would not exist.

Supervision has been the most corrupting factor in anesthesia, it has allowed many to make money by watching other do the job and has bred resentment on both sides of the fence.
 

powermd

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A SS H OLE PATIENT WITH NAPOLEONIC COMPLEX: (patient acting very aloof) "Its not mister Smith. Its DOCTOR Smith."

JET: (still in dark) "OH DUDE! Sorry about that, doc. Whatcha practice?"

A SS H OLE PATIENT WITH NAPOLEONIC COMPLEX: "I have a PhD in English."
[/B]
When patients pull this entitled narcissistic defensive bs I don't even shake my head and laugh to myself anymore. It's because I realize the guy's title is all he has.

To paraphrase Yoda- Money, employability, respect... an English professor better care little for those. A humanities PhD is a fairly self-indugent thing to pursue. There's no shortage of people who want to make a living, even a meager one, teaching college students Shakespeare. They chose their path, they knew the consequences, I don't have sympathy for an unhappy English PhD.
 

IN2B8R

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I practiced with a fellow physician several years back who left medicine to become a catholic priest.

His name was Martin.

He was an amazing individual to know/interact with/work with.

A truly faith driven man, albeit non-judgemental, who during the time I knew him was a practicing physician awaiting God's guidance.

Martin eventually left medicine for the priesthood. He literally gave up everything he had materially, told his girlfriend he was becoming a priest...

at this point you, the reader, is thinking "Jet, what the f u ck?"


Relax.

I continue:


Martin and I were chillin in the doctor's lounge one day. I was intrigued by his commitment....by the message he was receiving....kinda cool s h it.

Martin, amidst our conversation about whatever, recites some important vatican thinghy that says

"THERE IS ONLY ONE TRUTH."

Martin remarked that the passage was self explanatory.

I WANT YOU TO SIT ON THAT STATEMENT FOR A MINUTE.

THERE IS ONLY ONE TRUTH.

WOW.

I'll always remember that conversation with Martin, since the content of said conversation had a major impact on me.

OK OK OK BACK TO THE THREAD

When I see a nursing group politically taking a stance to blur the boundaries between

BEING A PHYSICIAN AND BEING A F U KKING NURSE....AND SAID F U KKING NURSE WANTS TO BE CALLED 'DOCTOR"

it really upsets me.

The term DOCTOR

is reserved for people who went to med school.

Only insecure PhDs demand the DOCTOR title: (true story follows....bald headed, ugly, short, fiftyish dude comes for a lap chole:)

JET: "Hey, Mr Smith? Yeah hi! I'm Dr Jet, one of the anesthesiologists here. I'm gonna put you to sleep for your gall bladder surgery. You're gonna do fine. We are gonna take very good care of you."

A SS H OLE PATIENT WITH NAPOLEONIC COMPLEX: (patient acting very aloof) "Its not mister Smith. Its DOCTOR Smith."

JET: (still in dark) "OH DUDE! Sorry about that, doc. Whatcha practice?"

A SS H OLE PATIENT WITH NAPOLEONIC COMPLEX: "I have a PhD in English."

I tried not to spit my gum out in laughter.

I think I lowered my head and shook it a little.

Back to the thread, Jet....

OK.

"DOCTOR", when used in a way that our society understands, refers to a dude/dudette who went to med school and did a residency. Who practices MEDICINE. Who makes their living being a DOCTOR. The term "DOCTOR" does NOT include nurses with a "doctorate" nursing degree.

You've read this long post.

I want you to remember one thing, and one thing only:

THERE IS ONLY ONE TRUTH.

Like Martin said.

Like the Vatican said.

Anyone who hasnt been to med school who calls themself DOCTOR

does not realize

HOW MUCH THEY ARE LYING TO THEMSELVES. AND TO THE WORLD.

There is only one truth.
:thumbup::thumbup: This post should be part of the permanent archives; better yet, etch it on fuggin' stone and have it readily seen on the front lawn of every hospital/ASC--just like the Ten Commandments!
 

cfdavid

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In the spirit of others on this thread, and expanded on by Jet, frankly I don't worry about CRNA BS anymore.

There is only one truth.
 

DScully

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Sleep,

How and when do you bring this up? I'm just having a hard time coming up with a way to make a smooth segue from Past Medical History to The Difference Between The Various White Coat People.
Not sure if I can respond to this question since it is not directed to me...but this is what I think I will use at the end of conversation.

"Oh, one last thing that I would like to mention...I know that things can be confusing while you are in the hospital / with all the different people talking to you / etc., but I just want to inform you that in the future, should you need any surgery, make sure to ask for an anesthesiologist to take care of you, instead of a solo CRNA. It is very similar to surgery - you want to have a surgeon to operate on you, instead of a nurse. You can have a nurse looking over you but you want to make sure that an anesthesiologist, a doctor, is supervising him or her."

This will probably take 1min...so probably too long a speech??

I guess I'll find out when I start my residency...........
 

kmurp

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'Anesthesia has already been hit and hit hard by nurse practitioners."

How have we been hit and hit hard? Seriously, I don't know. Typically, anesthesiologists who practice with high CRNA ratios actually make more money than those who work personally performed or with fewer CRNAs. The groups hiring these CRNAs have done so either to make >the median or needed lower cost per room due to poor revenue per room.
 
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I'm on Ob/Gyn right now and I go to a school at a major medical center...this is a typical example of what a nurse does:

Me: I'm looking for the release of records authorization form, do you know where it is.

Nurse: Huh? I don't know what you're talking about.

Me (getting pissed off but can't show it since im a student): You don't know what a release of records form is?

Nurse: You probably have to go to medical records for that form (then she turns to her computer which is open to facebook)

Me: No I know they are at this station I just don't know which drawer its in.

Nurse: (shes now ignoring me and on the phone) How do they look on you? Well I can't give u my opinion without seeing them. Facebook me a pic and I'll let you know.

In the end I found the form without her help.

I have so many more stories of how useless these people are. I can't even imagine trolling facebook or instant messaging with my friends while im on service.
 

tncekm

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Not sure if I can respond to this question since it is not directed to me...but this is what I think I will use at the end of conversation.

"Oh, one last thing that I would like to mention...I know that things can be confusing while you are in the hospital / with all the different people talking to you / etc., but I just want to inform you that in the future, should you need any surgery, make sure to ask for an anesthesiologist to take care of you, instead of a solo CRNA. It is very similar to surgery - you want to have a surgeon to operate on you, instead of a nurse. You can have a nurse looking over you but you want to make sure that an anesthesiologist, a doctor, is supervising him or her."

This will probably take 1min...so probably too long a speech??

I guess I'll find out when I start my residency...........
I was thinking something more along these lines:

I know that, with all the people around here, things can get confusing. So, if you ever want to see a "physician or surgeon" in the future, make sure you request them specifically by those titles. Nurses actually may hold an academic doctorate, so simply asking for a "doctor" may not actually get you in touch with your physician. :cool:
 

scrubswannabe

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I'm on Ob/Gyn right now and I go to a school at a major medical center...this is a typical example of what a nurse does:

Me: I'm looking for the release of records authorization form, do you know where it is.

Nurse: Huh? I don't know what you're talking about.

Me (getting pissed off but can't show it since im a student): You don't know what a release of records form is?

Nurse: You probably have to go to medical records for that form (then she turns to her computer which is open to facebook)

Me: No I know they are at this station I just don't know which drawer its in.

Nurse: (shes now ignoring me and on the phone) How do they look on you? Well I can't give u my opinion without seeing them. Facebook me a pic and I'll let you know.

In the end I found the form without her help.

I have so many more stories of how useless these people are. I can't even imagine trolling facebook or instant messaging with my friends while im on service.
only thing about your example is that those are most likely RNs which are nurses with probably a 2 year Associates Degree from a Communtiy College or maybe a Bachelors Degree

We shouldnt assume DNPs who go through 4-6 more years of schooling than RNs will act the same way


But seriously this just sucks...
 
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only thing about your example is that those are most likely RNs which are nurses with probably a 2 year Associates Degree from a Communtiy College or maybe a Bachelors Degree

We shouldnt assume DNPs who go through 4-6 more years of schooling than RNs will act the same way


But seriously this just sucks...
You're right she was a RN but imo a DNP is a glorified RN and to think about it in another way...can u ever imagine a MS-1,2,3,4 ever acting like this? Years of training can't change ingrained behavior. The very fact that these clowns actually think they are as proficient as physicians shows how unprofessional and utterly clueless they are.
 

tncekm

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We shouldnt assume DNPs who go through 4-6 more years of schooling than RNs will act the same way
Straight from your BSN, you can get it done in 3 yrs.

And, you get to complete it by taking such wonderful courses as "NURS 550 White Privilege and Racism in Health and Human Services (3) or NURS 566 Occupational Stress and Stress Management (3) or NURS 579 Transcultural Nursing Practices (3)"

http://www.son.washington.edu/students/dnp/docs/Possible-Courses.pdf <-- look through that RIDICULOUS list of courses.
 

kmurp

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You're right she was a RN but imo a DNP is a glorified RN and to think about it in another way...can u ever imagine a MS-1,2,3,4 ever acting like this? Years of training can't change ingrained behavior. The very fact that these clowns actually think they are as proficient as physicians shows how unprofessional and utterly clueless they are.
Funny, I haven't found nurses to be "utterly unproffessional and clueless". I actually married one - she's not either of those things. Just a small suggestion from someone with more mileage on them (me): don't let these feelings that you have show. Someday, in the not too distant future, you are going to have a bad outcome (patient morbidity/mortality). If you are perceived by the nursing staff as an adversary,you risk being hung out to dry. Nurses can be quite helpful; you will need to treat them well to enjoy this help.
Lastly, unless you are quite advanced for your age, you likely have a great deal to learn clinically. Nurses in specialized units who are experienced, can teach the green intern much and keep them out of trouble. Just a suggestion.....
 
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Funny, I haven't found nurses to be "utterly unproffessional and clueless". I actually married one - she's not either of those things. Just a small suggestion from someone with more mileage on them (me): don't let these feelings that you have show. Someday, in the not too distant future, you are going to have a bad outcome (patient morbidity/mortality). If you are perceived by the nursing staff as an adversary,you risk being hung out to dry. Nurses can be quite helpful; you will need to treat them well to enjoy this help.
Lastly, unless you are quite advanced for your age, you likely have a great deal to learn clinically. Nurses in specialized units who are experienced, can teach the green intern much and keep them out of trouble. Just a suggestion.....
I hope you are right b/c in the first two years of med school we were continuously told how important good relationships with the nursing staff is and how important a role they have. I came to the floors with that expectation and while I can't say I have a huge sample size to base my opinions on, I have rotated through a major community hospital that is part of the largest health system in my state, in one of the busiest VA hospitals in the country, one of the largest public hospitals in the country and my home institution which is a major regional medical center...and my experience with the nursing staff be it on the floors or in the OR while working with Anesthesia has almost always been sub-optimal at best.

Nevertheless, you're advice is well taken. And as almost every med student I have ever met, I will continue to approach every nursing interaction with the professionalism expected of our field.
 

Planktonmd

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This is not about titles or social status!
It is about one simple thing: MONEY!
As long as they offer a service for less money they will have customers who will come to them and call them whatever they want to be called.
People in this country in general are willing to sacrifice some quality to pay less money and this applies to insurers and public agencies as well, the Payers will accept a lower standard of care as long as they can save money.
So, nurses are the future of medicine in this country and it will be the only advanced country in the world where health care will be predominantly provided by nurses.
Unfortunately the organizations that represent physicians in this country are no political match to the nursing unions and organizations and they have already lost the fight.
All we can do at this point is learn how to live in this new world and accept it.
 

2win

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This is not about titles or social status!
It is about one simple thing: MONEY!
As long as they offer a service for less money they will have customers who will come to them and call them whatever they want to be called.
People in this country in general are willing to sacrifice some quality to pay less money and this applies to insurers and public agencies as well, the Payers will accept a lower standard of care as long as they can save money.
So, nurses are the future of medicine in this country and it will be the only advanced country in the world where health care will be predominantly provided by nurses.
Unfortunately the organizations that represent physicians in this country are no political match to the nursing unions and organizations and they have already lost the fight.
All we can do at this point is learn how to live in this new world and accept it.
Australia - the same poiltics - http://www.theaustralian.com.au/news/nation/push-for-nurses-to-take-doctors-roles/story-e6frg6pf-1111118505211
I do agree that the fault belongs to physician organizations...
I do not agree that I have to accept to live in this "new world" - simply I cannot give it away without a battle.
Like Jet said :
"THERE IS ONLY ONE TRUTH!!!"
 

pgg

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I'm on Ob/Gyn right now and I go to a school at a major medical center...this is a typical example of what a nurse does:

Me: I'm looking for the release of records authorization form, do you know where it is.

Nurse: Huh? I don't know what you're talking about.

Me (getting pissed off but can't show it since im a student): You don't know what a release of records form is?

Nurse: You probably have to go to medical records for that form (then she turns to her computer which is open to facebook)

Me: No I know they are at this station I just don't know which drawer its in.

Nurse: (shes now ignoring me and on the phone) How do they look on you? Well I can't give u my opinion without seeing them. Facebook me a pic and I'll let you know.

In the end I found the form without her help.

I have so many more stories of how useless these people are. I can't even imagine trolling facebook or instant messaging with my friends while im on service.
You should've filed a quality control form (or whatever your hospital uses).

Nothing gets a lazy nurse's attention like a formal QCR that documents her laziness and how it obstructed patient care. Protocols, procedures, and paperwork are the most important things they do.

A phrase like "too busy surfing Facebook to help me care for a patient" on an all-important un-ignorable piece of paper goes a long way toward recalibrating attitudes.
 
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You should've filed a quality control form (or whatever your hospital uses).

Nothing gets a lazy nurse's attention like a formal QCR that documents her laziness and how it obstructed patient care. Protocols, procedures, and paperwork are the most important things they do.

A phrase like "too busy surfing Facebook to help me care for a patient" on an all-important un-ignorable piece of paper goes a long way toward recalibrating attitudes.
Yeah I am figuring out what is the procedure here...thanks to this nurse medical records at the OSH closed for the weekend by the time i found the form and faxed it and now she is in pre term labor and we don't know her immunization status/infection status so i think the plan is to redo everything here and waste money that probly wont get reimbursed by medicaid.
 
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esperRN

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I'll give you a hint for dealing with males nurses (since I am one and all my buddies are like this). Explain things to us and we'll be your best friend. A doctor on my unit, that all the female nurses hated because he had a temper and was basically a tool, taught me all the time when I asked what was happening on a weird EKG, CXR, rare pathophysioligy or whatever. In return, I defended him to every nurse that had one negative thing to say about him. Hurt my relationship with the other nurses, but I only really care about the people making me better.

I'm sure this is gonna get some negative backlash but I thought I would let you know you can be the biggest dick to me as long as you enjoy teaching me.
 

DScully

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I'll give you a hint for dealing with males nurses (since I am one and all my buddies are like this). Explain things to us and we'll be your best friend.
Appreciate the insight!!

What about female nurses? They tend to be the ones that I am afraid of the most...any suggestions?
 
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