I'm sure I'm going to start a perfect storm of feces by saying this on allnurses, but here goes:
Nurse practitioners are getting dumber and dumber. There was a time when I would have used a nurse practitioner as my primary health provider without hesitation; when I would have even preferred an NP over an md. They were more careful, more thorough, and listened better. There was a time when I preferred dealing with nps over residents as providers in the ICU. They were more careful, more thorough and listened better. Those times are past.
I'm not saying I don't work with some good nurse practitioners. I work with twelve of them on a regular basis, and three of them are excellent, one has potential. The rest . . . Not so much.
It's not just that they're young and inexperienced. Youth is fleeting and inexperience can be cured. It's that they're not careful, not thorough and they don't seem to listen. Worse than that, at least six of the eight seem to believe that they're "Better than bedside nurses". Smarter, better educated, more aware of what's going on with the patient (from their vast experience and the copious time they spend with their patients in between shopping and doing crosswords on the internet) and better able to communicate with the attending physician than we are.
I don't deny that a nurse practitioner has a master's degree. But so do I, so does bethany, and so do some of my colleagues. One even has a phd. (OK, so it's in literature, but she has a phd.) yes, nps have more nursing education, but it seems that they have so little bedside experience they don't even know what they don't know.
The most dangerous nurse is one with about two years experience. They've got enough experience to be competent -- barely -- but not enough to know what they don't know, and too many of them think they know everything. Unfortunately, that's about the stage most of our nps were in when they graduated from their MSN programs and became nurse practitioners. So what we have in the ICU is eight nurse practitioners with two years or less of bedside experience, all of whom think they know everything they need to know about being a bedside nurse and most of whom think they know more than the experienced ICU nurse they're working with. But they don't.
Youth is fleeting and inexperience and ignorance are curable, but arrogance is dangerous. An NP who is so impressed with the initials after her name that she won't listen to the RN who has been at the bedside for ten years or more and who has been there, seen that is vastly more dangerous than a bedside RN with two years of experience. Even a two year nurse who is convinced she knows everything. Worse, the brand new nurses will listen to the NP with all of the initials after her name, whether or not she actually knows what's going on, before they'll listen to the experienced bedside nurse responsible for their orientation.
What brings on this rant, you ask? The NP who ordered amiodarone for the patient with the paced rhythm because she was so sure it was ventricular tachycardia. "We don't need to defibrillate him because he has a good blood pressure," she said self-importantly. "But let's load him with amiodarone." she wouldn't believe it was a paced rhythm when I showed her the rhythm strip with all those cute little pacer spikes. She wouldn't believe it was a paced rhythm when I showed her the 12 lead. Unfortunately, this is just one in a series of similar incidents.
About the amiodarone -- she did believe it was a paced rhythm when I showed her what happened when I turned off the pacer. (lots and lots of cute little pacer spikes and none of those wide qrs complexes she was so sure were v tach.)
They want to be nurse practitioners -- OK. That's great. But please listen to the experienced RN at the bedside. She just might teach you something.
See, here's the thing..."my staff." You don't own anybody. Staff may work with you, but they don't belong to you.
True I do not own the staff...the use of the word my in this case is not meant to indicate ownership but rather a relationship. Do we not say my mother, my child, my co-workers (or do you say: the people I work with)? Do we own them?
Just because you may have been treated badly in the past does not give you license to do the same to others. That was your wording on two separate posts. It makes me wonder if you don't share those same sentiments.
I used the terms only to indicate that there are those who do see those who are NOT equally trained/educated as underlings; similar to military ranking. I did NOT say I did this. It is because of the past that I make every attempt to not act arrogant or think of myself as any less or more important than any others of the other hospital staff. I put my pants on the same way as everybody else.
Wow. Some folks really just enjoy picking it apart. First, let's beat up on someone who's spell checker made pedestal into pedal stool and then let's read one sentence where a theoretical "boss" treats someone like "underlings" as a direct attack on ourselves.
HECK! Let's expand it! Its an assault on nursing executed by some evil aide turned RN turned APRN-C! I knew it!
Sick of the ugly discord around here and sick of unrealistic folks who think nursing school should be like it was in the dark ages, people who disagree with them just can't measure up to their years of experience so they are the authority on everything (eyes rolling now) and RNs are really the super-secret top dogs of the whole health care system who can write magic orders that nobody ever signs!
Wow. Some folks really just enjoy picking it apart. First, let's beat up on someone who's spell checker made pedestal into pedal stool and then let's read one sentence where a theoretical "boss" treats someone like "underlings" as a direct attack on ourselves.
HECK! Let's expand it! Its an assault on nursing executed by some evil aide turned RN turned APRN-C! I knew it!
Sick of the ugly discord around here and sick of unrealistic folks who think nursing school should be like it was in the dark ages, people who disagree with them just can't measure up to their years of experience so they are the authority on everything (eyes rolling now) and RNs are really the super-secret top dogs of the whole health care system who can write magic orders that nobody ever signs!
Like all systems, health care has its hierarchies. We need hierarchy. It promotes organization. It promotes good care. An RN should not be entering orders and then (fingers crossed) hoping someone signs them. Its a double edged sword: Someone signs them? Its a thankless task since it was their butt on the line. No one signs them? Your butt is on the line.
Do I think the NP "outranks" me? Sure do. Do I think the MD outranks them depending on your state and in my state? Yep.
If I don't like it? I should get my advanced practice degree. Where did this every one is the same as every one else attitude come from in health care? It isn't realistic.
Someone has to be the leader, especially if their license is the one on the line. If its your license primarily at risk here, then you better take point here, my friend. (Not to mention who am I to tell you what to do with your license?)
Back to what I said originally: think NP programs are designed for people with experience, not newbies. Had two women and a man from my nursing class that started MSN programs 8 weeks after finishing their BSN. 8 weeks!
Specializes in Oncology; medical specialty website.
Okaaaaay! (As we say with attitude in Atlanta!)
Like all systems, health care has its hierarchies. We need hierarchy. It promotes organization. It promotes good care. An RN should not be entering orders and then (fingers crossed) hoping someone signs them. Its a double edged sword: Someone signs them? Its a thankless task since it was their butt on the line. No one signs them? Your butt is on the line.
Do I think the NP "outranks" me? Sure do. Do I think the MD outranks them depending on your state and in my state? Yep.
If I don't like it? I should get my advanced practice degree. Where did this every one is the same as every one else attitude come from in health care? It isn't realistic.
Someone has to be the leader, especially if their license is the one on the line. If its your license primarily at risk here, then you better take point here, my friend. (Not to mention who am I to tell you what to do with your license?)
Back to what I said originally: think NP programs are designed for people with experience, not newbies. Had two women and a man from my nursing class that started MSN programs 8 weeks after finishing their BSN. 8 weeks!
I don't know where you're coming up with nurses writing their own orders, but whatever. If a nurse can't see that's wrong, that's on her/him.
I don't know where you're coming up with nurses writing their own orders, but whatever. If a nurse can't see that's wrong, that's on her/him.
I work in a hospital as an RN every week, 3 shifts a week. People routinely write their own orders at both of my jobs. In fact, some of the MDs even expect most orders to be written for them and then complain when they don't like what was verbaled to them.
I understand from other RNs that this practice was once extremely common with RNs playing de facto MDs. I find the practice shocking and ridiculous. You can get a real order from a real MD by simply asking.
I was also under the impression that some people here were implying that RNs should have an equal say in what was ordered. They sugar coated it with team dynamic lingo and experience=know how but I still felt that that was likely what was being said. I have also seen that attitude at work. I don't think an RN does have a right to say a bunch about what someone orders because it isn't their license. I have no problem speaking up about incorrect orders or questioning orders I don't understand but if some MD/NP just loves Ultram or just never does Zofran, I don't think I can tell them their being irrational and silly just because I think patients do better with fill in the blank med.
Specializes in Oncology; medical specialty website.
I work in a hospital as an RN every week, 3 shifts a week. People routinely write their own orders at both of my jobs. In fact, some of the MDs even expect most orders to be written for them and then complain when they don't like what was verbaled to them.
I understand from other RNs that this practice was once extremely common with RNs playing de facto MDs. I find the practice shocking and ridiculous. You can get a real order from a real MD by simply asking.
I was also under the impression that some people here were implying that RNs should have an equal say in what was ordered. They sugar coated it with team dynamic lingo and experience=know how but I still felt that that was likely what was being said. I have also seen that attitude at work. I don't think an RN does have a right to say a bunch about what someone orders because it isn't their license. I have no problem speaking up about incorrect orders or questioning orders I don't understand but if some MD/NP just loves Ultram or just never does Zofran, I don't think I can tell them their being irrational and silly just because I think patients do better with fill in the blank med.
But I will advocate for my patient by telling that practitioner that the patient does better on another drug. I think that's my responsibility. I won't attempt to order it myself, but I will state my case. That's my job.
But I will advocate for my patient by telling that practitioner that the patient does better on another drug. I think that's my responsibility. I won't attempt to order it myself, but I will state my case. That's my job.
I was speaking about generalities. Personally, I think Zofran is a wasted trip to the pyxis for someone who is vomiting but I don't share that with every md that ever orders it. As for specific patients who respond better to specific drugs, I have done the same as you say you do.
KYAPRN
14 Posts
True I do not own the staff...the use of the word my in this case is not meant to indicate ownership but rather a relationship. Do we not say my mother, my child, my co-workers (or do you say: the people I work with)? Do we own them?