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.
What about all the first+ year resident doctors that have NO expiernce at all? I've been a nurse three years and I'll be the first to admitt I certainly on know a fraction on the grand scale of things; however, I've seen nurses in many areas who have 10, 15, 20+ expiernce
What about all the first+ year resident doctors that have NO expiernce at all? I've been a nurse three years and I'll be the first to admitt I certainly don't know a fraction on the grand scale of things; however, I've seen nurses in many areas who have 10, 15, 20+ years of experience who do the bare minimum. Just because your a young nurse does not mean your incompetent and that you can't make a great NP.
What about all the first+ year resident doctors that have NO expiernce at all? I've been a nurse three years and I'll be the first to admitt I certainly don't know a fraction on the grand scale of things; however, I've seen nurses in many areas who have 10, 15, 20+ years of experience who do the bare minimum. Just because your a young nurse does not mean your incompetent and that you can't make a great NP.
To be fair though, first year residents are still advised by senior residents and attendings, plus thousands of hours of clinical hours and 4 years of didactic and hands on training prior. I mean RNs are set free into to the wild in 2 years of schooling, some even in 16 months.
I do agree with your second point, I've seen some young NP's 25-28 that were sharp as a tack and older ones that lagged behind. Ultimately, I think it has to do with the NP schools accepting everyone and their mother (literally) that you get such candidates from both the excellent and subpar spectrum of diagnostic and professional caliber. IMO, NP schools should demand only the best and brightest with recommendations plus experience.
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!
You have a hard time relating because you aren't working in oncology.
I say listen to the patients. I've never taken any anti emetic myself, but my patients say that ondansetron really works well for them. As a prescriber, I prefer it's SE profile to the others, I can tell you that for sure! But I listen to the patients. If there is a safe drug that works well for them, it is a good choice.
This entire thread leaves me empty. The basic question for me is: "IS ANYONE INTERESTED IN THE BRASS TACKS OF TAKING CARE OF PATIENTS ANYMORE?" Seems to be a contest of "my degree is higher/better than YOUR degree" and a never ending push to pile degrees higher and higher. Just sayin'.....
The truth is bedside nursing is very difficult physically and emotionally and many of those who remain at the bedside are the walking wounded, in chronic pain, anxious, depressed with health problems such as HTN, etc from being overworked and overstressed thru the years. Also shift work increases the chances of miscarriage, cancer, diabetes, HTN, and obesity to name a few. The longer you stay bedside, the more likely you will experience harassment, mistreatment, mandation, and work related injuries!
Instead of being angry at the nurses who choose to leave the bedside, realize what needs to happen is changes to improve working conditions, pay, etc to encourage more nurses to stay at the bedside. A no lift environment is long overdue for starters! No mandatory overtime! I don't know how long you have been a nurse, but if you stay at the bedside for many years you will pay a price physically and emotionally!
What about all the first+ year resident doctors that have NO expiernce at all?
Because first year residents are not set loose. They are supervised and and must prove themselves through 3 or more years residency, 2 or more years fellowship, making substantially lower wages than other MDs, and working substantially more hours.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
you're right that bedside nursing is very difficult, both physically and emotionally. and i'm sure that older nurses have more cancer, diabetes, hypertension and obesity. actually getting older is the biggest predisposition to aquisition of those maladies!
as far as harassment, mistreatment, mandation -- i'm less likely to experience those than i was when i had twenty years less experience. work related injuries -- also less likely because i'm smarter about it than i was in my twenties when i thought i was invincible. although a case could be made that the longer one stays in a job, the more one's chances of experiencing a work-related injury!
i'm not angry at nurses who choose to leave the bedside -- i just think that with the education model we have for nurse practitioners, they need to actually be at the bedside for awhile before going through an np program. you cannot leave where you haven't been.
True, probably getting too A&P/patho for my science challenged brain to understand completely. (My NP school friends impress me learning MORE science. So glad I'm going a different direction.)
AshleelRenee
39 Posts
What about all the first+ year resident doctors that have NO expiernce at all? I've been a nurse three years and I'll be the first to admitt I certainly on know a fraction on the grand scale of things; however, I've seen nurses in many areas who have 10, 15, 20+ expiernce