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BostonFNP Guide 34,790 Views

Joined Apr 4, '11 - from 'Northshore, MA'. BostonFNP is a Primary Care. Posts: 4,142 (59% Liked) Likes: 9,477

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  • Jun 11

    Within past few years have done inpatient and outpAtient psych in NH OR and MN. Have found most if not all practitioners (MDs and APRNs) to be competent and diligent.

  • Jun 11

    Totally agree, the threat of losing their (MD’s) cash cow incites defensiveness and/or “Might-Makes-Right” arguments. The medical professionals that maintain altruism are typically more understanding and look at evidence.

    I’ve yet to see any evidence that NP’s provide substandard care. Articles that attempt to, do so with anecdotal, opinions; not evidence. It doesn’t take much experience to find a doc with a false sense of entitlement. Likewise, as a profession, NP’s need to be diligent to maintain professionalism and the highest level of care. We also need to stick together. I’m amazed at home many NP’s are not involved with their local professional organizations or who are not involved with local and national legislation.

    Quote from BostonFNP
    How long have you been working as an NP? I only ask because some of your comments are typical reactions in the first year or two of practice.

    I think you really answered your own question: there are good/bad docs and good/bad NPs and good/bad PAs and good/bad patients. I actually have a term I use called the "trifecta" for the many patients that come to me on a benzo, stimulant, and a narcotic. Who knows that's treating what.

    I've found that most docs that have negative comments about NPs are not the "good ones" they are the ones worried about the $ not patient care.

    Do you think that psych NPs are better educated and prepared for practice in psych compared to NPs in primary care?

  • Jun 3

    I have very strong opinion about this topic. The pendulum has swung too far the other way. All of this "opioid crisis" and the increased overdoses have little to do with the real patient that is in pain. Weaning a patient off pain meds to make it easier for pain control post op is torture of a patient that cannot get relief. Frankly in my opinion it is delay of treatment and malpractice.

    I am on some powerful pain meds right now and frankly, I am sick to death of being treated as if I am endangering the general public with my narcotic pain use or I am secretly behind the pharmacy shooting heroin. I have been sick for a year now and a 9 month hospital stay and still have another surgery to try to fix me. I am sick to death of being treated like a terrorist just to get pain relief. These new "laws" will NOT stop the heroin crisis or the use of IV Fentanyl by rock stars. Their drug addiction has absolutely NOTHING to do with my pain.

    I do not take my pain Rx to get high. I take my meds as prescribed for the relief of pain. I do NOT expect complete relief but I do expect to have enough relief so I may function I wish (I had enough strength and was well enough to confront the lawmakers and the family members of those who died of overdose and tell them of my nightmare of relentless debilitating pain that I have to beg to get someone to believe me.

    While I understand the need for awareness the pendulum has swung too far in the opposite direction and patient who really need relief....can't get any meds

  • May 26

    Quote from avengingspirit1
    There was no scientific process here. Just a group of self-serving academic lackeys who got a bucket load of funding and nice bonuses to boot to push the agenda of the very people and institutions backing and supporting them. The authors know this which is why they refused to return a call from a major news network inquiring about it. You will not see a refuting study mentioned in any nursing publication because there is no money to made that way and most of those publications make a lot money selling advertising to four year schools. And coming from a former business background, anyone with common sense knows non-profits are a joke, what they make, they can't call a profit. But they do make money as I know for fact working for one currently.

    I outlined facts about the study in above post. And to remind you, those were facts in the study itself- not my anecdotes. The authors banked that the average person could not see flaws and accept the conclusions carte-blanche as being unquestionably true. The only thing I will agree in this "study" is that ones chances of survival are probably better having surgery in a hospital with more board certified surgeons. But as far as proving people fare better in hospitals with more BSNs - garbage. You do what you feel you must do and I will do the same
    The "pro-ADN" folks are more than welcome to do studies and find that there is no significant difference between the results of ADN-prepared nurses and BSN-prepared nurses, and publish their results. If the existing literature is so deeply flawed, it shouldn't be difficult to come up with different results, right?

  • May 24

    This is an ethical and legal issue. By NOT reporting it, YOU are just as guilty.

  • Apr 6

    Quote from BostonFNP
    Finally a review addressed one of the main points I was interested in seeing in Vaxxed, given it's basis on the Thompson "whistleblower" information. As anyone who has read the study knows, the data in question involved only black males, so naturally the movie should focus on black boys with autisim right? Apparently there was only one in the whole movie. Why did if focus on white people is all that data was clearly published in the study that showed no link between autisim and MMR?
    Because the movie is "entertainment" so they could pick and choose what and who they wanted to present-an adaptation if you will. Not a surprise, given that the original data was manipulated to serve Wakefield's purposes. Might as well continue on in the same tradition.

  • Apr 6

    Please don't mischaracterize our choice in not seeing the film. We know what is in it. You don't have to watch the movie to know what the movie is about.

    We are not fearful. We are saddened and yes, as Far mentioned, disgusted that kids with autism are being used in such a terrible way.

  • Apr 1

    Concerned lady-

    I appreciate your passion on this subject matter. However, I have yet to see you present credible evidence that backs up your statements that vaccines cause autism. Several people here have given you links to proven, reputable, scientific studies that dispute your claim. Have you read those? If not, are you willing to? If not, then how can you condemn those who are not interested in seeing some pseudoscientific movie directed by someone who has been wholly discredited in the medical and scientific community? And for my own knowledge, are you a nurse?

    I don't have a neuron in me that believes vaccines cause autism. I do believe in rare cases some have adverse reactions to vaccines, some of which have lifelong effects. However, given the choice, I'd rather have a living autistic child than a dead typically developing one who died from a vaccine presentable disease.

  • Mar 30

    I happen to know many people in my network of people who happen to believe such ideas... The first thing I tell them that if it doesn't have APA style citations from credible sources such as universities or recognized medical journals then it is false until PROVEN other wise.... Next I encourage them to take a microbiology class (medical terminology class wouldn't hurt either now that I think of it) and they will quickly realize the falseness in these articles videos and stories..... I'm very passionate about this topic and could rant all day but I'll just leave it at that
    Happy nursing!

  • Mar 28

    I know this is resuscitating an old, possibly irrelevant thread, but I had new insights. When I first responded to this in 2013, I was nearly finished with my BSN and had acquired a lot of knowledge, quite a bit of it through the study and research needed to write those "useless" papers.

    When I went back yesterday and saw there had been a new comment, I decided to page through the original thread. I was surprised to learn that the paper the OP was complaining about was a concept analysis. I didn't know what that was back when I initially responded. Since then, I've been taking graduate level theory courses and am quite familiar with concept analyses.

    For any that go through this thread I wanted to share that while a paper on Caring, Hope, Trust or Fear seems completely stupid on the surface, it is not "just a paper". A concept analysis is a systematic process designed to help the reader (or writer) understand what that concept is and is not.

    This is can be extremely important especially when you get tired of hearing people carelessly throwing common or popular terms or catch phrases around. Want to have a healthy discussion with your upper management on their new standards of "caring" that don't seem to make much sense, you'd be surprised how they may pay better attention if you can speak intelligently on what caring IS and what caring IS NOT. Just one example.

    I did a concept analysis on "family centered care". What became apparent to me was that this term is used extremely loosely to incorporate most anything healthcare workers want to push in the NICU (or other settings, but I'm NICU focused). Doing that concept analysis helped me develop a laser-focused view on what family-centered care really truly is, and how this should be our main focus, but don't try to term something family-centered care when it's really consumer-centered business, I will call you out on it and cite chapter/verse (author, year, whatever).

    If you want a good explanation, and have some kind of library access there is this:

    Cronin, E., Ryan, F., & Coughlan, M. (2010). Concept analysis in healthcare research. International Journal of Therapy and Rehabilitation, 12(2), 62-68. DOI:10.12968/ijtr.2010.17.2.46331

  • Mar 26

    I'm coming back to thank this particular thread for opening my eyes to vaccines.

  • Mar 2

    I think I am tired of one half shooting their mouth off with nothing but an opinion. I saw an excellent post including citations to back up her opinion. Enough with the Kool-aid crap. I notice there was no respose to my statements of this Lil ole nurse running circles around first year residents. My experience and desire for knowledge made me a damn good nurse. I told an ARNP to go pound sand today because I don't feel she's in a position she belongs in. Does that mean all NP's or PA's are bad? Hell no. If your good at what your job is you have the respect of my 30+ years experience. If you don't put in the effort find another career. As a Nurse I can run circles around my 25 year old daughter. But I know my kid and I know she has the ability to become a damn good FNP because she works hard and practices harder. She has 2 great mentors her mother in law with 35 years experience and a dad with 30. To wrap it up she won't belong in critical care but she will kick butt in a Family Practice. I don't prefer MD'S I prefer DO's does that mean one is better than the other?

    Get real. Put FNP's where they shine. Good night yall gave me a headache

  • Feb 24

    The thing is what I name "Tina Jones problem".
    (For those who do not know, Ms. Tina Jones is a simulation patient used by Shadow Health, an online assessment training company used by many NP and medical schools for basic assessment training).

    Ms. Tina Jones is in her mid-20th, AA, obese, hypertensive, with DM type II and mild asthma, and a slew of other minor ailments for which she "is seen" in urgent care-like setting. Family history of heart disease. No primary care provider. No regular treatment for DM and HTN.
    Now, how many of just such Tinas come through ERs and UC centers daily in this country? Every health care provider, physician and down to possibly MAs, know how it all gonna to end. Tina is in her mid-20th now and feels just fine. If her health is continue to be "managed" like it is right now (i.e. no good glucose control, no weight control, no BP control, little if any exercise) she will get the first calls from her eyes and her kidneys in the next 15 to 20 years. She will have a pretty good chance to celebrate her 65th birthday being hooked to dialysis machine, and she will be lucky indeed if at this date she sees her birthday cake and still has both legs and not living in excrutiating pain. She will probably die from heart disease before or shortly after her 70th birthday.
    We all know it. There are tons of evidence around to confirm this prognosis. We also all know what needs to be done to avert it and let Tina live long and healthy life. In short, someone of us needs to get Tina to understand the seriousness of her situation and help her to manage her own health. Tina needs to be seen in office at least once a month, for the beginning. She needs to be spoken with, encouraged, taught, motivated endlessly. One needs to call her once in a while to make sure she checks her BP and sugar. She needs info about communuty programs, affordable gym classes friendly for African American women, maybe even some grocery coupons for fresh produce.
    Now, the health care provider who will do it all for Ms. Tina may not necesserily know the molecular mechanism of ACE inhibitors action. It would be nice addition, but not mandatory. What would be mandatory is his or her ability to connect, educate and motivate Ms. Tina, as well as willingness to speak and ability to answer questions the way Tina understands, because what we need is Ms. Tina taking her lisinopril DAILY as a prayer. Same (or worse than that) goes about Ms. Tina's diet, blood glucose control, etc.

    Doing a quick physical and writing a half a dozen scripts in ER will not help Tina. Only long-term, systemic, relentless and thankless care will, and I do not foresee doctors standing in lines willing to do this kind of jobs.

  • Feb 24

    Quote from BostonFNP
    Calling to verify that a order is correct is fine, and often appreciated. I am not sure that's what the initial post was about though. I don't think having concern is a "bad thing", don't get me wrong, I would be happy if someone called and verified it, or if a med was held due to concern for an adverse effect.

    I do think there is a lot of bias when dealing with these type of medications, which I don't feel is appropriate from members of the health care team. For example, do you have the same concerns about dosing insulin at breakfast and at lunch? There is a stigma about mental health in general, and IMHO, a stigma on the parents of children with ADHD.
    That's a fair point.
    Again, all my kids are "self serve", so to speak, so no.
    I would say-we see so many NON medicated kids out there, that a kid being on Ritalin or something of that ilk is usually more welcomed than not.
    (I can't speak for Cattz, of course.)

  • Feb 24

    I am an MSN/FNP student. I am also an IMG who passed USMLE and even did a year of IM residency before turning to nursing. It is another story why I did it, but I can see things from different perspective.

    To begin with, there are different doctors, nurses, PAs and so on. During my residency year I was NEVER required to interpret X-ray beyond the very basics, let alone CT or MRI, although I could order them any second. I was required to explain in details why I would want to order them, what exactly I was expecting to see, read interpretations and make conclusions, sometimes quite intricate, of what they could mean in context of the patient's symptoms, but that was that. I did total one big arterial stick and only started to do lines because I was following seniors like a tail. I never had to suture or cast or even put an IV in. Right now (in acute care, not ER) I have more than enough PAs and MDs who seem to never in their lives do anything "technical" at all. And do not even get me started on physical assessment skills. There are doctors who do not even auscultate heart when told about new (!) murmur in chronically septic (!) patient, leaving alone correct auscultation of all 5 points in 3 positions plus vessels. They just order ultrasound.

    Second, I am seeing quite enough physicians who are experts in their own area but feel extremely uncomfortable if things start to run even a little bit unpredictable way. I work with very complex patients and sometimes I have to literally spend my day calling one consultant after another and exasperating that a hospitalist "cannot" manage a patient with fever AND positive Kernig just because 1) fever is going under ID service and 2) positive Kernig is going under Neuro service. I also have to remind some doctors, on pretty much regular basis, to please discontinue all b-blockers if patient is getting Levophed drip, as just one example.

    I find nursing education deficient, on Bachelor's as well as so far on Master's level, that's why I got basic science textbooks (Lang's patho, pharm and biochem) and read them in my spare time to dust off my brains. They are not at all difficult to understand, BTW. But I have high suspicions that no amount of scientific knowledge will teach a person how to think clinically. Any technical skill can be taught to almost anyone given the right circumstances, but critical and clinical thinking is another thing. Unfortunately, critical thinking taught in BSN programs have nothing to do with what is required in real life, leaving alone provider's level. PAs do not have to make this transition, and I think this is the reason why they are perceived as "much easy to work with" by MDs. For many RNs I observe, moving from "problems" and care plans and, God forbids, policies governing their every breath and move to simple scientific explanation of, for just one example, why and how sepsis can cause elevation of AST/ALT and what does it mean implies a psychological trauma of a sort. Many of them, to put it mildly, do not much like people who tend to explain how human body works, and this discourages other nurses from furthering their education.

    I am absolutely sure that I could learn how to do sutures and lines if I need and want it. We have an optional class where FNP students who want these skills can learn basics in lab and later add a bit on clinical. We also have X-ray reading basics now and going to continue to do them through the program. I do a whole lot of my own physical exams (I am actually supposed to do real head-to-toe on every patient every shift, so I am just using the opportunity). But what I enjoy most is that my program pushes us hard to thinking as providers, not as nurses, and where they let us slack, I just do it myself