Content That Dembitz Likes

Dembitz 3,509 Views

Joined: Mar 5, '09; Posts: 53 (40% Liked) ; Likes: 77
Nurse Practitioner; from US
Specialty: 4 year(s) of experience

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  • Mar 22

    Quote from maberRN
    Our state law requires assent, not consent. .
    What does that mean?

    If a woman tests positive for opiates, do you do anything with that information, such as call CPS or notify anyone else outside the woman's/infant's care provider? If so, you are violating federal law if you're not first obtaining INFORMED consent, irrespective of what your state mandates (see US Supreme Court decision Ferguson v. City of Charleston). If you are JUST using the result to inform medical care, that's different.

  • Mar 20

    Quote from babyNP.
    Have you not heard of ?

    This is kind of basic newborn stuff, to be frank. What sort of NP are you and did you not have newborn training? I would try to educate yourself on the topic a bit more.

    To answer your question, again, frankly, you should not be asking internet strangers on how to manage a patient. Do you have an attending physician? They would be much more suitable to answer your questions. I couldn't without knowing more of the infant's history such as mom/baby's blood type, ethnicity, gestational age, bili levels drawn at which hour life, etc etc. I don't mean to be harsh, but not knowing how to treat a newborn with hyperbili could result in kernicterus, which is a "never" event in medicine and highly litigious, not to mention severe life altering for the patient and their family.

    Just getting insight. I'm a new FNP and this was my first experience with it. Last I checked, this is a place where people come to ask questions. Mine were fairly simple and something that I would know more with a little experience with the topic which I clearly stated I didn't. That website is new to me, but other tools and information I was reading said otherwise. I'll remember next time to keep my practice questions to myself. Thanks for a boatload of nothing.

  • Jan 19

    Quote from djmatte
    "Respectfully", at some point in life, I just might helping with hiring decisions just like right now I participate in the interviewing and hiring of RNs. Working on any team, group interviews are exceptionally common and a major factor for me and evidenced here a few others is experience that you bring to the team. And there's not "might not" help when it comes to rn experience. Any form of clinical patient interaction is infinitely more valuable than none. YOU may think you gain nothing from it, but you went direct entry yourself, so how would you know? You never took the time to work as and actually understand what it means to be an RN. You used the profession to fast track to primary care. Congrats on your ability to sell yourself in an interview and willingness to move anywhere. That's about all you needed to say in the original post.
    And you have never worked worked as a NP, so how can you judge whether RN experience is helpful, necessary, or whatever? You've never done the job, so you have no way to know what's helpful or not. No one is "using" the nursing the profession to fast track. That really sounds like you're taking the whole DE segment as a personal affront. It's a whole lot of feelings and perceptions that are not based on evidence. Are we not supposed to be an evidence based profession?

    There is not only one correct pathway to take to a destination. Medicine and health care are constantly evolving, and non-traditional pathways may become more prevalent. Those who cannot accept change and cannot adapt will not survive.

  • Jan 19

    To be fair, I don't see how nursing experience would help an outpatient primary care provider that much.

  • Jan 18

    Quote from Susie2310
    So the thread descends to the level of childish responses.
    Not childish, just a fact. I have plenty of children on my panel, including the children of physicians. I honestly do not want to see anyone who doesn't want to see me. I have said that from the get go.

  • Jan 17

    Quote from BCgradnurse
    What do you think we do all day???
    I basically sit in my ivory tower and judge people.

  • Jan 17

    Quote from EGspirit
    Call me naive, but maybe someone could explain something to me:

    But then the BSN becomes an NP, and now they're practicing low-skilled medicine, which isn't nursing at all! But they are the "Advanced Practitioners?"
    Low-skilled medicine? Please, enlighten us, what is the different legal standard that NPs have for the practice compared to physicians? What are the different quality of care measures? What is it exactly about NP practice that is "low-skilled"?

    Quote from EGspirit
    Seriously, wouldn't technical nursing certifications like ACLS and CCRN (or the other specialty certifications) really be what makes a nurse "Advanced."
    What makes an APRN "advanced" is the advanced scope of practice (based on advanced education, advanced knowledge base, etc). Specialty RN certifications demonstrate expertise at the RN level but they do not change the scope of practice.

    Quote from EGspirit
    I mean if my name looks like this:


    am I even a nurse anymore?
    Do the semantics really matter?

    On that topic, there is a semantic issue with the term "bedside" as well. What is your definition of "bedside"?

    Quote from EGspirit
    Why can't caring be the profession and leave medicine and surgery to the doctors, and the Ph.Ds to the Nursing school professors? Wouldn't being really good at running a code or starting an IV, or even being really effective at feeding and bathing a patient be the definition of the advanced nurse?
    Again, the role and the scope (and everything that goes with it) is much different between RN and APRN.

  • Jan 17

    Quote from FrankRN2017
    Unexpected Relocation with expiring insurance.
    Yet another common red banner for Schedule II and III scripts. Like being on a trip, on a vacation, on business conference, air company lost my bag, my car was broken into, that plumber guy stole my pills from my bathroom, I kept my pills in the basement so that kids wouldn't find them but it got flooded, etc., etc.

    We all know that these things and more of them happen in live but nowadays nobody would risk years of hard work, income and career just because it once happened with you. You, or any other such dude, can be the one triggering random audit of your prescribing practices.

    Next time, before you leave your prescribing provider, do staff-witnessed UDS for three months, then ask for a personal note about you being a good and entirely compliant guy with the doc's cell phone number on it, copies of those UDSs (all of them clean, of course) and a copy of your state prescription monitoring system run of your name. I cannot give you a guarantee, but it seriously can help. At least that's what providers want to see in Florida and other places where people who just lost their airbags and now have three hours before boarding their cruise ships tend to suddenly appear in primary care offices.

  • Jan 17

    What was the urgency here besides your desire for a testosterone refill? Am I missing something?

  • Nov 3 '17

    Quote from Wuzzie
    Nurses, teachers and school administrators are obligated reporters. With children and vulnerable adults we are required to notify the authorities of suspected abuse. It's a little stickier with adults that don't fall into the "vulnerable" category. If we suspect abuse we are required to assess the situation if possible and provide resources.
    Mandated reporters are only required to report suspected abuse that they encounter within the scope of their practice. So no a manager is not required to report to authorities if she see bruises on an employee. Think about it - In the course of daily living I see many thing's that "Just don't seem right" I would be forever reporting everyone if I was required to do so.

    Nor or we "Required to act outside our scope of practice." While most decent people would want to help they are not required to do so.

    As a scenario to show how ridiculous this is imagine walking in a large store and seeing some woman you don't know with bruises on her face. Do you, a total stranger to her, pull her aside and begin to investigate and assess for DV. Do you call the police to come right away before she leaves the store?

    I once was involved in a scenario where I saw an older woman walking down the street with a bleeding head injury, she was walking quickly yelling back over her shoulder at a man who was following her down the street. Concerned that I was witness to a possible crime in action I called the authorities and gave information about the location and followed the pair until the police arrived. I later found out that the woman in question had dementia and had fallen. The man following her was her son and he was waiting for her to calm down enough so he could walk her home and seek treatment for her injuries. Every thing is not always what it seems.


  • Nov 2 '17

    I've said this before...we don't have a medical director so a standing order/protocol isn't available to us to stock epinephrine. I wish we did.

    But my standing order is I answer to a higher authority than state law or district policy so if a child is having an anaphylactic reaction and God put me there to see it and there is no epi on the shelf for that child...I'm grabbing whoever's epipen that is the closest on the shelf, with the correct dosage or next best thing, and I'm using it.

    As a pediatric ER nurse who has handed dead babies to parents to hold for the last time or tried to make dead teenagers presentable for parents to view and hug good-bye forever, and as a parent, I will do everything within my means to snatch a kid from the jaws of death. To Hell with rules and laws and nurse practice acts and district policies...this is where I stand.

    Jen's post hit me between the eye's today as a reminder of how valuable School Nurses are as student and patient advocates and how valuable and functional this SN forum is...after wasting time and energy in participating in the attack thread today that was finally pulled by AN. OMG!! I love you guys like a brother or sister and appreciate what you do...just sayin. Keep on keeping on!!

  • Nov 1 '17

    Quote from SopranoKris
    The hospital I work at simply calls all NPs and PAs "midlevel providers", which to me, makes it sound like we're less educated.
    NPs and PAs ARE less educated than physicians. That does not mean they are lesser providers, but you will never win a "we are just as educated" argument. The numbers don't even begin to add up.

  • Nov 1 '17

    I am also a Direct Entry grad, and feel that RN experience is not related to success as an NP. What is crucial, IMHO, is finding a first position where you have a slow ramp up and have support from a mentor. That is true for any new grad, whether you have years of RN experience or not. As I have said a gazillion times, I rarely use the vast majority of what I learned in the RN portion of my program.

    I'm going to assume you're an FNP as you said you might explore working in the adult arena.I wouldn't want to work in peds as a FNP as we did not get a lot of depth in pediatric clinical and didactic. Peds primary care is tough. I've never seen a peds office, as a NP student or parent, that wasn't crazy-busy and hectic. Perhaps looking at an adult NP job or something like Urgent Care (except if you would be the only provider on duty) might offer you an environment that is more conducive to getting acclimated to this role. I'd look at a large medical group practice where you would have other providers to consult with, and might have a more structured orientation process.

    If you feel you have knowledge base deficits, then hit the books again, and brush up on the areas where you think you need to know more. Don't give up on nursing, or yourself. Not every job is a good fit.

  • Oct 19 '17

    Quote from elkpark
    And, yet, there is Federal law that protects the right of healthcare providers to decline/refuse to participate in procedures/care to which they object on religious grounds (specifically written to protect anti-choice healthcare providers), so there is legal precedent and legal protections in place for individuals who have religious objections to particular aspects of healthcare.

    I'm surprised at how many people here have posted that, if the OP has religious objections to some aspects of providing care, and his religious beliefs don't permit him to provide care for everyone, then he has not business going into healthcare. When anti-choice people come here to say that they want to go into healthcare but they have religious objections to abortion and are unwilling to participate in abortions, no one tells them that they shouldn't go into healthcare -- people practically line up here to assure them that they will be fine, there is law that protects their beliefs, they can't be compelled to participate, and all they have to do is work in a setting that won't involve abortion. That is all the OP is doing -- asking for suggestions about healthcare settings that would not conflict with his religious beliefs and observance.
    Yes, and it's a Federal Law to which I am vehemently opposed. As for your assertion that "When anti-choice people come here to say that they want to go into healthcare but they have religious objections to abortion and are unwilling to participate in abortions, no one tells them that they shouldn't go into healthcare -- people practically line up here to assure them that they will be fine, there is law that protects their beliefs, they can't be compelled to participate, and all they have to do is work in a setting that won't involve abortion.", au contraire, I don't believe they should go into healthcare either, and that would be my position if I ever read a post regarding the issue. Abortions are a part of women's healthcare and one shouldn't be able to pick and choose for whom they provide care, particularly based on supernatural beliefs.

  • Oct 19 '17

    Just as I don't believe that pharmacists should be able to refuse to sell Plan B due to religious beliefs, I don't believe health care providers should be allowed to pick and chose for whom they provide care based on religious beliefs. (That includes Catholic hospitals if they're getting government funding, but that's another issue, I suppose.) If your religion requires you to shun half of the population because of what does or does not dangle between their legs, you need to stay out of healthcare. Time for everyone to evolve.