Pain Management CRNA - page 4

So I found an interesting link on the AANA webpage, and I was curious what the group thought about it. I guess the AANA is currently trying to develop guidelines for fellowship programs in pain... Read More

  1. by   TejasDoc
    Quote from Hellllllo Nurse
    Thank you so much, loisane.

    TejasDoc hasn't been back. I was looking forward to his reply.
    Somehow, I think we won't be hearing from him.
    Hellllllo Nurse, I would hate to disappoint you, so here I am. I've been incredibly busy with my own training to get back here as often as I'd like. There are a lot of things in your message that I'd like to respond to. Here goes.

    Quote from Hellllllo Nurse
    ... The docs and students there ripped me to shreads.
    Sorry that happened to you. I'm not really sure what you said or what you asked, but I can tell you I understand about being jumped on by the majority at a bulletin board. You just have to get up and post again another day.

    Quote from Hellllllo Nurse
    really want to know- is there any mention in medical school of what nurses really do, what our education entails, and on how nurses and docs can best work together?
    I'm embarassed to say that I imagine at many medical schools, there is not. Mine may have been the exception, because I did have a formal class about the training and education of nurses and different advanced practice nurses. But it was elective, it wasn't part of the required curriculum, and it was literally just ONE class, not a course, but a class.

    Quote from Hellllllo Nurse
    Do you have any thoughts or opinions about this? Are physicians concerned about the nursing "shortage", nurses leaving nursing and how this will impact their practices and the state of pt care?
    I've honestly not thought that much about it, and maybe I should, I've been a little obsessed with my own situation recently. I'm a new resident, you can imagine, it's somewhat overwhelming.

    I can tell you what I do, and I try to make a conscious effort of it. The nurses I work with are great. They're smart, qualified and they work really hard. I try really hard to be nice, to thank them every time I get a chance, and defer to their opinions when I know they know more than I do. Not a day has gone by since I started that I haven't learned something from a nurse I work with, and I make sure they know that. I try to make my relationship with them as pleasant as possible. If the nurses I work with aren't happy with their work environment, I didn't cause it. That's my contribution.

    I'm really sorry that you've been treated badly and called nasty things ... all I can do is try not to be that way myself.


    Hmmmmm, I don't know where you are, but I wish I had interviewed at a program that put residents at the front of the bus. Last I checked they just shortened my work week to 80 hours ... wow, what luxury. And now, I can only work 30 hours in a row. Yep, I'm pampered. Lucky for me I make less money as a resident than I did when I graduated from college. Maybe if you all run up to the front of the bus, we can tip the thing over and I can get a couple extra hours of sleep.

  2. by   Hellllllo Nurse

    I'm very glad to hear from you.

    I worded my inquiry on the medical student and physicians' bb almost exactly as I have worded it here. In fact, maybe verbatim.

    Like, you, I am Texas. Most of the poor treatment I have received occured in another state, but it's happened here, as well.

    I feel that the issues of the nursing shortage and the future of medicine and pt care are irrevocably intertwined.

    I feel that physicans' educations should include a required component on nursing, and medical issues as related to nursing.

    I would like to ask you- do you know what nursing diagnoses are? Not medcial diagnoses, but nursing diagnoses, aka NDX?
    Last edit by Hellllllo Nurse on Jul 12, '04
  3. by   loisane
    Quote from Hellllllo Nurse
    I feel that the issues of the nursing shortage and the future of medicine and pt care are irrevocably intertwined.
    Undoubtly true. I don't think either of us was surprised by TDs answers, it only validates what we were pretty sure of.

    However, IMHO, we can't count on others to fix this for us. It's not enough for medical schools to talk about nursing. I think it needs to me more integrated. Some schools are developing more "health care" courses, which are multidisciplinary. That gives the professions experience in interacting together, and in the process learn about each other.

    Nursing dx? Sheesh, where do I start? While I agree with the idea in principle, I end up siding with the group that finds little practical value in them. Bottom line, I think the definition and description of nursing care is still in evolution. We might need to get the kinks worked out a little more, before we can realistically expect these (or something similar) to be very helpful to those in other disciplines. I do agree that Nursing dx and the related discussions are important. So the appropriate goal might be for other professions to be aware of them.

    Your point that physician's treatment of nurses contributes to the shortage is right on. And MDs should absolutely be held accountable for that. You are probably aware of the "magnet hospital" designation. These are hospitals that have no trouble with recruitment and retention, even during times of shortage. One of the factors identified that make magnets different, is the nature of the nurse-physician relationships. You can bet health care administrators are aware of this.

    TD, your positive attitude is admirable. Work hard to hang onto it. There is something about medicine that eats away at that spirit. I have seen many a resident hardened in the process of evolving professionally. But the ones that hang onto that positive spirit, they are the very best of people. They are great to work with, and they are the best care givers to their patients. Heaven knows we need more of that in health care, for the good of all of us.

    loisane crna
  4. by   gvgodglry
    Quote from jwk
    Just curious - does this technically fall outside your scope of practice? (it may not, I don't know, that's why I'm asking) Maybe there are some different laws for hospice. Seems like ordering scheduled narcotics, which really is what you're doing, would be problematic, if not for you, then certainly for the pharmacy. I'm surprised they'll take the order. Don't orders/prescriptions for scheduled drugs require a physician signature, particularly Morphine which is Schedule II?

    Wow, I wouldnt be bragging abou this too much. Standing orders that are meant to be initiated uner the understanding a Dr knows about them is one thing. Calling in meds for pts to go home with and making decisions without getting a Dr approval first is taking a huge risk. When you call the pharmacy they should ask you what Dr is prescribing it. If not they might be assuming if the same doctor uses that pharmacy from your particular facility. I worked ltc for a while and we would have to fax orders we thought should be administered to the Dr for approval. Although they almost always went with our suggestions because we knew the pt better I would never just assume the Dr will always sign my order later. The one time he decides not too your license is on the line, as well as the Dr if they sign off on all nurse orders automatically. Advanced practice nurses can order drugs in some states but not RNs.

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