Doctors-in-short-supply-responsibilities-for-nurses-may-expand - page 2
from ny times blog prescriptions.... november 6, 2009, 9:00 am with doctors in short supply, responsibilities for nurses may expand by michelle andrews... Read More
Nov 8, '09Quote from migeI paraphrased you there but the problem with your logic comes from what appears to be your obvious inexperience. The primary flaw in your logic is is the fact that despite the numerous hours of experience med students and residents put into their training, the quality of their care is often comical. How often do I see med students and residents standing around, gossiping, studying? Completely oblivious to the goings on around them? How often are they really part of the hospital team? Not much. Just because you are inside of a hospital doesn't mean your are learning anything that is actually useful. Massively piling hours up sounds like a recipe for incompetence to me.Can you please provide the study that you mentioned above? Can you please provide a specific percentage of nurses that have experience when they begin graduate school?
I will provide the medical side of view:
Med student 1st and 2nd years in class from 8-5 every day.
3rd and 4th years in the hospital/clinics 5-6 days per week from 8-5 and staying until 12AM when on call with residents and in some places overnight.
Resident for IM spends 70 hours per week in average at the hospital which translates to 3640 hours per year so at the end of a 3 year residency they have 10920 hours of experience if the avg is 70 hours. This 10920 (give or take since we have 3 weeks of vacation so thats 210 less hours) hours doesnt take into account the hours that resident spend at home/library preparing for the Step 3 (weeks-1 month of preparation) and ABIM (4-5 months of preparation) and reading after their duties in the hospital....
In terms of pathology/treatment training you cannot compare one to the other, they are different with very different training objectives in mind. And again this is not to flame, is just to ilustrate that physicians and nurses have different roles in the healthcare system and they were trained for a specific objective.
Since very few doctors have ever gone to and most to this day truly don't know what a nurse actually does, the unknown fact is that nursing school is at minimum a two year crash course in how TO RUN A HOSPITAL FROM THE GROUND UP. On the flip side, nurse's have to know what a MD does to do their job. MD's frankly consider 90% of the necessary functioning of a hospital someone else's problem. This makes MD's weak and ineffectual. I find med students and even up to R2's utterly clueless on how to contact the resources available to them (i.e. lowly custodial staff, dieticians, social workers) to efficiently wrap up a case and help expedite a patient's care.
In addition, I regularly meet physicians with numerous years of experience who find that when other members of the team ask them to do something a certain way, like writing orders, to follow the standardized procedure, they simply will not do so. The primary reason why MD's are so spectacularly ineffective in their roles is their utter arrogance to admitting the fact that 1) other people are as important as they are and 2)that every time a physician decides to do things "their way" it costs untold man hours to rectify the problem and get the patient back on track.
Nurses are responsible FOR EVERY SINGLE PROBLEM THAT ARISES. WE KNOW HOW TO FIX PROBLEMS QUICKLY AND WITHOUT NURSES DOCTORS ARE UTTERLY UTTERLY USELESS. NURSES ARE ALSO RARELY GIVEN CREDIT FOR SAVES, EMOTIONAL THERAPY TO DE-ESCALATE ASSAULTIVE OR DISTURBED PATIENTS, ALL THE LITTLE FIXES, THE THINKING AHEAD. IT IS EXPECTED OF US. NURSES DO NOT EXPECT TO GET CREDIT. DOCTORS DO. DOCTORS HAVE CREDIT SEEKING BEHAVIOR.
When a nurse decides to transition into the practioner role, if in their practice they are treated with the same professional respect as MD's I have found them to be far more effective, getting the job done with out so many displays of tantrums and blatant disregard for the job everyone else has to do. MD's have the luxury of being told they are so very very important from day one. Nurses are taught we are not as important from day one. We have learned to diagnose and treat in a round about way, integrated into our standards of practice so as to not dare cross over into the "medical" model and dare speak a diagnosis. As if what nurses do isn't "medical" from the second we step into a hospital. Being trained "in the medical model" doesn't make you a jedi warrior, it's hilarious when a M.D actually brays that from their lips. What nonsense.
The bottom line is that this change in roles, this impending tidal wave of need has been brought on by doctor's themselves, who for the last 60 years have been running around touting their incredible powers of mind and yet have been in fact, accomplishing extremely little.
Prime example: Last night I worked registry in a local E.R. The on staff, full time physician ordered a bladder irrigation for a patient, s/p bladder resection from bladder CA. Large amount of spraying blood, gross hematuria, fair amount of blood loss. M.D. refused to consult pt's urologist. I asked the wife to call. She did. We did this without E.R. M.D. knowing.
E.R. M.D. didn't know what type of fluid to use for irrigation. Didn't know how much. Didn't know how fast. Wasn't worried about blood loss. "Have to get the clots out" was his mantra.
Didn't want to pay to have coags drawn. Didn't want to type and cross. Patient nearly died. Pt didn't die because I: 1) drew coags, drew type and screen and broke the rules when I put two on cross later. 2) I called a darn urologist cuz I didn't want the patient to bleed out. 3)I started an 18 guage IV without permission. 4)I demanded he get a uro consult. When uro consult came he admonished moron doc in front of all of us and 5)pt was rushed to or where HE DIDN'T DIE. Doctor didn't thank anybody, was oblivious to THE HOURS OF MANHOURS HE wasted when it took 5 RN's to get the show on the he road and get the work done. AND THEN HE PROCEEDED TO ATTEMPTED TO TAKE CREDIT FOR THE WHOLE SITUATION IN FRONT OF UROLOGIST WHO THEN ADMONISHED HIM. THIS IS A REGULAR OCCURENCE. I was expected to clean up an incompetent doctor's mess.
I can tell you, no med student on earth would ever, will ever, know how to handle that situation. A nurse with one year of experience will. Your argument logically looks great, just like a nice lab coat and a clean pressed shirt with a tie. But the argument is own by the reality of what happens, day in and day out in every hospital in America. No matter how smart the doc is, they simply cannot fix all the problems with any level of efficacy that they think they can.
And I'll tell you something, because of that experience, because of this article, so help me god, I'm going to NP school. And in three years I'll be healing people the right way, with HUBRIS, but I will not hesitate to take or give credit when it is and where it is deserved.
Nov 8, '09Quote from sonnyluvOnce again, anecdotal evidence is nearly useless. I don't know what hospital you work in but I can tell you that the majority of doctors are not like this. You should provide adequate data and argue rationally rather than that emotional rant you just tossed out. Provide citations to a valid study that indicates that doctors are arrogant jerks who seek credit even if they don't deserve it. So, to reiterate, anecdotal evidence = nearly useless.Everything you said.
If you think doctors' training is not good, what do you think of NP/DNP training then? It's true that NP/DNP training is considerably less than that of physicians. So, it logically follows that, in your opinion, if the rigorous medical education of physicians isn't enough to properly take care of patients, how can the significantly less amount of training that midlevels receive translate to providing better care?
Just like your quip about "being trained in a medical model doesn't make you a jedi warrior" neither does being trained in the nursing model. You're right that without nurses, it'd be very hard to run a hospital. However, the same goes for running hospitals without doctors.
So, to reiterate, please take the time make a rational arguement instead of responding emotionally since it's pretty obvious, based on your post, that you are anti-physician.
Nov 8, '09Quote from dgenthusiastme pleasureprovide citations to a valid study that indicates that doctors are arrogant jerks who seek credit even if they don't deserve it. .
i'll let you find the rest, i must assure you there are plenty.
Nov 8, '09First link doesn't work.
Second link: did you seriously read that study all the way through before you posted it? This study was essentially designed to reveal stereotypes held by nursing and medical students about each others' professions. It had nothing to do with objectively assessing whether or not these stereotypes were in any way true.
Sorry, the fact that a group of 39 undergraduate nursing students in the United Kingdom in the 1990's tended to view physicians as arrogant is not evidence that physicians in the United States today actually are. Give me a break.
Nov 8, '09Quote from Zana2Ranier beat me to it but yea, the first link doesn't work. And the second link is a horrible study that surveys medical and nursing students about stereotypes. I hope you realize that surveys in general are not really objective studies of something (you know, because there's a lot of subjectivity involved). So, you've linked one study that we can't see and one horrible study that you didn't seem to have read through or if you did read through it, didn't realize what its flaws were. I really hope you're not an NP/DNP because, from the number of statistics courses their curricula offers (and I don't know why it does since it's supposed to be a clinical degree), one would hope that their skills at assessing research would be better. I have also looked around for other studies since you "assure [me] that there are plenty." However, I have not found any such studies at all.Me pleasure
I'll let you find the rest, I must assure you there are plenty.
Nov 8, '09What I never understand is why anyone here even bothers to engage with the APN-bashers who sometimes post here. It's not like you're going to change their minds ... They're entitled to their opinions, and are free to not ever see an APN if they think we're so awful and incompetent. But why waste your time debating with them about this?? Why not just ignore them?
Nov 8, '09Can't we all get along? Everybody has a role to play. Some have more education. Some more experience. The mid-levels where I work are fabulous. And the docs know they couldn't make it without them (as evidenced when a physician has to do anything their mid-levels usually take care of.) And the mid-levels know when to pass something along to the physicians. And the nurses clean up all the messes made by either. Nobody is saying a PA or NP should go do brain surgery. But my PCP is the PA in the office, and she's fabulous. And having worked with the MD in that office, I'm actually more comfortable with her *judgement* than his. The fact is, how much education/experience you have can be totally irrelevant to how good your judgement of a situation is.
Healthcare is a big world, there's room for all of us.
Nov 8, '09Quote from elkparkWhat I never understand is why anyone on here sees valid criticism as just midlevel-haters. If you've read through my previous posts in several threads, I have repeatedly mentioned that I wholeheartedly support midlevel utilization. The one thing I'm against is independent practice for NPs/DNPs where no physician collaboration would be required. I have also presented my viewpoint in as objective a manner as I could by presenting my analysis of various NP/DNP and MD/DO curricula and pointing out the significant differences between medical training and NP/DNP training. I'm not alone in voicing these opinions; many even in the nursing community itself are starting to question whether the NP/DNP curricula provides adequate training to justify both a doctoral degree and independent practice.What I never understand is why anyone here even bothers to engage with the APN-bashers who sometimes post here. It's not like you're going to change their minds ... They're entitled to their opinions, and are free to not ever see an APN if they think we're so awful and incompetent. But why waste your time debating with them about this?? Why not just ignore them?
So, why don't you actually read what we say instead of becoming so defensive every time a criticism, no matter how valid, is made against the NP/DNP profession? A lot of the NP/DNP curricula is very similar to that of the MPH curricula; I don't feel that's adequate training to practice independently. If you want, I can repost my analysis of NP/DNP curricula and my comparison of them with that of MD/DO curricula. I'm more that willing to change my opinion if there are valid, well-designed studies that indicate the midlevels provide similar levels of care as physicians do even with significantly less training. However, as I've pointed out several times, the studies currently out there are either significantly flawed in how they're designed or they're led by extremely anti-physician PIs, such as Mundinger.
So, to reiterate, actually read what we "APN-bashers" actually say and maybe you'll notice that we do bring up some valid points and are not rampantly attacking your profession with emotionally charged statements.Last edit by dgenthusiast on Nov 8, '09
Nov 8, '09Quote from woohI feel that people kind of avoid answering questions when they just respond with "can't we get along?" And anecdotal evidence is weak at best; I feel like I repeat this statement way too often on this site. How would you feel everytime a nurse brought up a complaint about a physician, the response you received was "Can't we all get along?" followed by an anecdotal story about some doctor that person knew who was great? Wouldn't it get pretty annoying? Similarly, you shouldn't respond with "can't we all get along" everytime a criticism is raised against NPs/DNPs and avoid answering the tough questions.Can't we all get along? Everybody has a role to play. Some have more education. Some more experience. The mid-levels where I work are fabulous. And the docs know they couldn't make it without them (as evidenced when a physician has to do anything their mid-levels usually take care of.) And the mid-levels know when to pass something along to the physicians. And the nurses clean up all the messes made by either. Nobody is saying a PA or NP should go do brain surgery. But my PCP is the PA in the office, and she's fabulous. And having worked with the MD in that office, I'm actually more comfortable with her *judgement* than his. The fact is, how much education/experience you have can be totally irrelevant to how good your judgement of a situation is.
Healthcare is a big world, there's room for all of us.
Nov 8, '09when my 3 kids were growing up an doing the regular pediatric office thing, they added a NP who is still with them today she was the most wonderful addition to that office, my kids never got better care, a more thorough exam and she was instrumental in picking up on my youngest daughter's symptoms to be that of Crohn's disease- I love her!! I would recommend anyone to going to see a NP over a Doctor anyday!!! The NP's I have dealt with in the hospital as a fellow clinician are just as wonderful and very receptive to us staff nurses- I love having NP's to go to. I hope that they will be major players in the healthcare reform- it only makes sence- cost effective sence and better more thorough care sence. If the government would throw some educational grant money my way I will be first in line to be an NP or APN for a clinic.
Nov 8, '09Quote from elkparkProblem being, some of us are not APN bashers. In fact, I am all for advanced practice nursing. I am simply concerned about this massive push for independent practice. No collaboration, no agreements, no chart review, nothing. This is a push that concerns me as a Registered Nurse because in my undereducated little mind I cannot see how APN's are educated well enough to provide full independent practice that is synonymous with a physician.What I never understand is why anyone here even bothers to engage with the APN-bashers who sometimes post here. It's not like you're going to change their minds ... They're entitled to their opinions, and are free to not ever see an APN if they think we're so awful and incompetent. But why waste your time debating with them about this?? Why not just ignore them?
APN's are not awful or incompetent, they are just not physicians. This is the crux of my argument.
Nov 8, '09I might add- the NP's I have had contact with are older and have a great deal of experience- they did not jump form a new grad BSN , no clinical experience into a MSN/NP program. they did have clinical practice experience as a foundation- I don't see how any one could do that job description without a good solid number of years experience base. there would be a tremendous lack of understanding for the inter-relationships of all the sciences( pathophysiology- signs and symptoms the sharp assessment skills, microbiology, pharmacodynamics)-
Nov 8, '09The competence level of the nurse practitioners I have worked with is at least as high as the competence level of the MD's I have worked with. The #1 stumbling block of many doctors is their own arrogance.
Rant finished. I'm an RN, not a NP. The health care system in this country is collapsing. We have the world's most expensive healthcare, but only the 41st best results. Something has to change. If you have no healthcare, is seeing a NP better than no healthcare? Family practitioners are already overloaded with patients, they can not physically see 30-40 million more patients. I think that the emphasis should be on the "nurse practioner" shortage more than the "nursing" shortage--which is not here yet, but is coming. The most effective doctors are the ones who know how to be part of a team that treats a patient, not the ones who think they are God. Nurse practioners already have the "team" concept in their mind because most of them have worked for years as nurses.
I would like to see NP's still having oversight from MDs, maybe the DNP could be a higher level degree which wouldn't require oversight, but 3-4 years experience as an NP before getting the DNP.
The US has the 41st rated healthcare in the world. Its probably about the 100th rated healthcare if you don't have insurance. The uninsured patients that "don't cost any money" according to popular thinking are the most expensive patients in the system. These patients are the drug addicts that are in the hospital several times a year, diabetics that can't afford meds and have their legs amputated, hypertensives that have strokes, etc. Each of these patients cost the healthcare system hundreds of thousands over a lifetime. There are probably millions of these patients nationwide. If you work in a hospital 1/4 to 1/2 of your patients are like this.