Latest Comments by BostonFNP

Latest Comments by BostonFNP

BostonFNP Moderator 34,217 Views

Joined Apr 4, '11 - from 'Northshore, MA'. BostonFNP is a Primary Care. Posts: 4,068 (58% Liked) Likes: 9,278

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  • 2
    cayenne06 and elkpark like this.

    Quote from twozer0
    do not have a problem with that, as a matter of fact I prefer it. I've been a nurse for going on 9 years and during that time I've gotten to build a lot of professional relationships with Docs, NP's, and PA's (my best friend is a CRNA).

    I know I'll get a good experience because I am hand picking my preceptors and they are happy to receive me. It would be less worthwhile to get tossed in with someone I didnt know and be at the mercy of someone who doesnt mesh well or is just overall bad at what they do.
    It's great that you have done your research, have the contacts, and have secured good preceptors you have known.

    That being said, in this situation, you potentially miss out on an important experience. I have been involved in clinical teaching for both medical and nurse practitioner students and there is an important aspect of placing students outside of their comfort zone. This means in clinics they may not have chosen, in roles they are not "interested in", and with preceptors that will challenge them. This is what I appreciate about programs in which the faculty evaluates each student and matches them with a preceptors and sites that cover a broad spectrum.

  • 0

    Quote from PMFB-RN
    The Akin study didn't separate those RNs who entered nursing with an associates or diploma and then went back for a degree later from those who entered nursing with a BSN or higher.
    So I don't see how it can be used as evidence for BSN as entry to practice.
    I'm not sure why it matters, in fact I think it is a strength of the study. I think people read the study and say "we need BSN entry" but really what I think it means is that nurses that are lifetime learners in the long run make better nurses.

    If the study showed that, on average, a nurse that started as a diploma nurse and went on to gain both experience and education had better outcomes than a diploma nurse that did not, then it's is much more compelling argument than a new-grad to new-grad study. New grads don't stay new grads for long, the real issue is the whole career.

  • 1
    elkpark likes this.

    Quote from avengingspirit1
    You're not as smart as you think you are; And from reading you other posts going back as far as 2011, you come off as smug and thinking you're the smartest in the room.
    Is ad hominem all you have left to argue? It goes perfectly with psuedoscience mentality.

    Quote from avengingspirit1
    It's a Landmark lie. The data pool for the study on BSN staffing and mortality rates was used for an earlier study about staffing levels and mortality generally. The information was simply copied onto another template for the study. The authors then said they would simply factor out the results from first study for the subsequent study. Then they only included data that was given the green light by the very people backing and supporting this fabrication.
    It's a study that you don't believe not a lie. A study published and vetted by one of the most respected peer-reviewed publications in the world. If you don't like the methods, get involved in research and repeat the study and move the profession forward rather than calling everything you don't like a lie and a shill.

    Quote from avengingspirit1
    And I don't believe for one moment you are not trying to defend this study because you have no irons in the fire Because every time someone brings out the truth about it, you are right there to put a ridiculous spin on it. You're the Jonathan Gruber of the Aiken study. That's why you're moderating on this site. So save it for the young college students you're trying to dupe. Go back and tell your colleagues the farce is over and there are a lot of PO'd people who now know they were duped out of thousands of dollars because those affiliated with academia are afraid of having to compete in the real world. I made my intentions very clear; I'm going to do to those driving the BSN push what they have done to new nursing school grads over the last few years.

    And I have had things published in my locale. But I'm not going to identify myself on this site. You'll find out as I push back further.
    And we return to the ad hominem and shill argument. If you want to contribute than do so in a meaningful way. Making posts like this if laughable.

  • 3
    PMFB-RN, elkpark, and TiffyRN like this.

    Quote from avengingspirit1
    P.S. Any other study I've seen referenced the Aiken study and even cited it in their sources. Talk about regurgitation! The ION made its recommendations solely based on the "Faiken" study. Because that's exactly what it is.
    That's because it is a landmark study. You would cite it no matter if you were supporting or refuting it. You have never published anything I assume.

  • 2
    PMFB-RN and elkpark like this.

    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.
    What bonuses? Cite your sources.


    Quote from avengingspirit1
    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.
    The for-profit schools making all the "money" are often associate programs, so there should be plenty of cash available. Please, cite the "four year schools" that have taken out advertisements in JAMA.

    Quote from avengingspirit1
    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
    So you are willing to cherry pick data from a "garbage study" huh? You have very eloquently defined pseudoscience: you take your opinion and search out only data that supports it. And at the same time you are accusing others of the same....

  • 3

    Quote from Susie2310
    Knowing what I know about my family member's medical condition etc., it was entirely appropriate for my family member to be admitted as an inpatient, and this was clear by the treatment the hospitalists provided. Why make such a comment when you know nothing about our situation?
    How long have you been a ED physician?

    That's the problem with trying to judge medical negligence by "standard of care": it doesn't matter what you know, or I know, or even what the attending hospital knows, standard of care is determined by what a reasonable provider in the same scenario would have done (in this case what another ED physician would have done). In simple terms it's what the bare minimum is and that's not a good way to decide, as is evidenced by what your family member went through.

  • 5

    Quote from Susie2310
    Having a lawyer present would make nurses/physicians attentive to ensuring the care they provide meets the Standards of Care and that their charting truthfully reflects the care they have actually given. I'm pretty sure if a lawyer had been present watching the ER physician preparing to discharge my family member (who had previously been discharged from a hospital stay within the last 30 days) who had sepsis and who required three days of inpatient care with antibiotics and IV fluids (the physician fortunately changed their mind after they had traumatized us by talking about discharging my family member home to receive antibiotics and had even started the discharge paperwork, and admitted my family member to a monitored unit), that the lawyer would have whispered CMS and EMTALA in the physician's ear.

    Profit, profit, profit. Volume of patients. Avoiding 30 day readmission penalties. And so on, and so on.
    Sure we can have a lawyer at the bedside and everyone can get full-body CT scans for every complaint, I mean why not, already 30-50% of CT scans performed are medically unnecessary and use has risen to over $100 billion in cost. Then in another few decades we can have other lawyers suing the current lawyers over the increase in cancer rates.

    Better yet, why not leave the lawyers out and just let every patient dictate their own plan of care? You have a cut toe, what would you like? An MRI? Sure thing. Then no one is to blame right? Except for the fact higher patient satisfaction scores are associated with higher M&M.

    You realize even in the situation you described, discharging your family member may have very well met the standard of care. It's a terribly inaccurate measure of medical negligence.

    Let providers practice the way they were trained to rather than by the way a lawyer, or patient, or administrator thinks they should.

  • 2
    caliotter3 and elkpark like this.

    Quote from avengingspirit1
    You can keep on trying to defend this garbage just like the AACN who supported and backed this nonsense for obvious reasons, but the truth is coming out. I contacted a popular radio station who briefly talked about the topic to try to get the issue pushed on-air again.
    I am not really defending anything other than the scientific process; these studies don't apply to me and I don't have any "horse in the race" so-to-speak. If a quality study comes along to refute it then my position would change. You can call it "garbage" and regurgitate the objections of the N-OADN (talk about bias) but until there is a study published that refutes it, you are spurting only your personal opinion supported by anecdotes.

    Good luck with that, I will be waiting to hear about it in the news. If some for-profits get shut down along the way, that's a bonus to everyone.

    All studies have flaws, I don't particularly love the 2003 Aiken study for an entirely different reason, but this has been replicated over and over in multinational studies by different authors using different study designs.

  • 3

    You have made a big investment, don't shortchange it. You first year in practice is very important and shouldn't (IMHO) be mixed with also trying to learn a completely different role.

  • 0

    Quote from avengingspirit1
    We don't know how many nurses were originally ADNs who went back to get BSNs. Those nurses would by default have more experience from working as ADNs before they got their BSNs. This factor alone seriously compromises the study's validity and produces flawed conclusions as it does not simply target a population of ADNs and BSNs.
    [IMG]http://allnurses.com/attachment.php?attachmentid=22302&stc=1[/IMG]

  • 1
    ShaneTeam likes this.

    Quote from Susie2310
    I saw a post on the internet that said that care would improve if a trial lawyer was present when care was provided. I agree.
    I think lawyers are one of the biggest obstacles to quality care.

  • 0

    Quote from DoGoodThenGo
    Well the profound leukocytosis might have been noticed in this case had anyone bothered to look at the lab results; but apparently that did not happen. IIRC it took five hours for the results to make their way back to the ER. By that time the kid had been discharged with the standard "take Tylenol and call your physician or return if conditions do not improve...."
    I just read through some of the details, out of curiosity, and there seem to be many errors, and all seem (to me) to stem from pigeon-holing the diagnosis, and later snowball into a major mistake. I speak to my student about this (both medical and NP) because it can ruin a career or result in a loss of life. You can never enter a room to assess a patient with a preconceived diagnosis. If the peditrician called an expect into the ED for the patient "to get fluids for a GI illness" (which makes some medical sense, gastroenteritis leads to hypovolemia and subsequent hypotension and reflex tachycardia) and that ED provider entered the room with the notion the patient only needed fluids, a mistake was ripe to happen.

    Then it is compounded by a lab result taking 3 hours, shift change, and the failure to notice/communicate that the fluid resuscitation did not improve the tachycardia, failure to call a critical lab, etc.

    I just wonder if it could have been avoided if the ED provider was more suspicious on initial evaluation. Although in his defense, it seems to lay people to be unfathomable to misdiagnose sepsis as gastroenteritis, but the truth is that the presentation for many rare and dangerous conditions is very similar or exactly the same as much more commonplace benign illness.

  • 1
    ShaneTeam likes this.

    Failing to notice a profound leukocytosis is absolutely an error and and error that should have been avoided; most facilities have a protocol for reporting and documenting critical labs.

    But it also highlights one of the more difficult aspects of medicine: there are harms in over-testing and harms in under-testing so a fien line needs to be walked and providers need to mix both the science (EBP) and the practice (the art) of medicine.

  • 1
    Aromatic likes this.

    Quote from Aromatic
    The op and his classmates probably are.

    It it usually is simple. Eat healthy and exercise. Lol hard to convince people to do that. We prolly need to have a staff of car salesmen in our offices pushing patients to have better lifestyle
    Then they will get humbled pretty quick when they get to practice.

    Why eat healthy and exercise when there is just a pill I can take?

  • 1
    Purrsx2 likes this.

    Quote from Aromatic

    If we did not have medicine, APRNs would not exist.
    Do you think without nursing, medicine would exist?

    No one here is (seriously) seeking to "unplant" physicians or "show they are better than others".

    I really love when people talk about "simple algorithim type disease". Anyone that has spent even the slightest amount of time treating them knows it is rarely ever simple. If NPs did nothing but perfectly manage hypertension, diabetes, and hyperlipdemia it would be the largest reduction in morbidity and mortality in the history of medicine.


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