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.
Specializes in Oncology; medical specialty website.
Funny, we use Zofran all the time in O/P OCN., and it works quite well. Worked pretty good for post-op n/v. Depends on what you're using it for. Where I work, we love it. (And Emend.)
Funny, we use Zofran all the time in O/P OCN., and it works quite well. Worked pretty good for post-op n/v. Depends on what you're using it for. Where I work, we love it. (And Emend.)
For people who are actually vomiting? It seems to work nicely for people who feel nausea/ morning sickness and those drama queens that spit into the bags and call it vomiting but on people who really throw up? It's just a waste of my time and it is my pet stinking peeve. I am convinced it will soon be replaced by whatever new expensive drug the drug reps bring in and I can't wait. But no, I don't share that with the practitioners. No need to stress them. They will soon be ordering something else for the same patient, a reglan or phenergan likely.
Have heard onc people say they think it's miracle stuff and I have a hard time relating. Oh Also read that the onc patients get huge doses daily. We start with 4 mg in er!
Funny, we use Zofran all the time in O/P OCN., and it works quite well. Worked pretty good for post-op n/v. Depends on what you're using it for. Where I work, we love it. (And Emend.)
It has been my experience both as a nurse and a surgical patient that Zofran does work marvelously for preventing nausea if given before the procedure or immediately afterwards but not so with stopping vomiting. Zofran onset of action is 10-30 min; peaking in 2 hrs; Phenergan IV is 3-5 min on set of action
Specializes in Oncology; medical specialty website.
For people who are actually vomiting? It seems to work nicely for people who feel nausea/ morning sickness and those drama queens that spit into the bags and call it vomiting but on people who really throw up? It's just a waste of my time and it is my pet stinking peeve. I am convinced it will soon be replaced by whatever new expensive drug the drug reps bring in and I can't wait. But no, I don't share that with the practitioners. No need to stress them. They will soon be ordering something else for the same patient, a reglan or phenergan likely.
Have heard onc people say they think it's miracle stuff and I have a hard time relating. Oh Also read that the onc patients get huge doses daily. We start with 4 mg in er!
I don't know if this has been brought up, but there is a difference between acute care NP's and family practice NP's.
I would think that any acute care NP would have to sort of know his/her stuff from time spent in the ICU as an RN (ICU experience is very much what one needs to get into the acute care (in hospital) side. I wouldn't dare go into acute care myself as I've only done med/surg and tele. I very much plan to do family care only, not that it will be easier ...there is a hugely broad area of knowledge and I've had NO experience as a nurse in primary care.
That said, I know my own school requires at least 2 years of some sort of hospital nursing experience for admission. Remember, also, NP's develop their skills over about a year in clincals, with most schools requiring some 700 to 800 hours of clinical time prior to graduation. For us, it's about 3 days a week, 8 hrs a day in a clinical. I'm sure I'm bound to learn quite a bit there.
I'm TOTALLY glad I had some experience as a bedside nurse ...but the things I'm talking about here is simply exposure to patients, the ability to communicate with them, and assessment skills. Other than that, everyone else is sort of taught over again in NP school -- you take patho again, but learn it from a completely different perspective. Same for pharm and assessment. You take some nursing theory, but other than that, you're pretty much done w/ the "nursing" part (or by now, it's just assumed you think that way) You are not following more or less a medical model, but trying to treat the patient wholistically.
I'd say -- provide YOUR rationale to that NP for why or why not something should be done -- and perhaps SHE will teach YOU something you didn't know ... I've learned a LOT more about drugs as an NP and now understand why certain docs won't order things the way I'd think they would.
But, provide your rationales and communicate -- same as you'd do with the doc. And maybe you can come to an agreement.
And remember, a lot of people decide to go to grad school and be NP's, because they can't seem to get any traction as a nurse ...nurses are far too busy undermining each other, writing each other up, and all that ridiculous CRAP. For me, I know it would take me YEARS to get ahead due to all of the politics, all of the favoritism ... and I don't have "years" as i am getting older. If anything, that is what I hope to get away from ...not necessarily patient care. Oh, and 12 hour shifts. . . maybe. Hopefully.
Med school is looking more and more desirable, more so than NP/PA school. You know what gets my goat? A NP or PA that plays MD/DO. There's one PA who does this. She might as well have been a MD/DO. And you know what, I might just go that way. Last thing I want to be seen as is a pretender, making less money than an MD/DO.
Med school is looking more and more desirable more so than NP/PA school. You know what gets my goat? A NP or PA that plays MD/DO. There's one PA who does this. She might as well have been a MD/DO. And you know what, I might just go that way. Last thing I want to be seen as is a pretender, making less money than an MD/DO.[/quote']
ME TOO!
Last thing I want to do is live a perpetual residency where I attend 3 years of grad school instead of 4 so I can end up deferring to someone half my age with a fraction of my patient care experience because I went to NP/PA school.
This is especially true in the ER. I love the ER. I never want to leave it and the scope of practice for an ER NP? It sucks and is super super limited. I don't want to suture lacerations or bust abscesses or perform what amounts to chart audits on trauma patients (adding whatever orders the docs forgot) as my main roles in the ER.
VICEDRN, BSN, RN
1,078 Posts
Should correct my typo before I get crucified: they're, not their.