platon20

I have a few comments: 1. CRNAs, even in 100% independent CRNA groups in independent practice states, don't make the same as MD anesthesiologists. MDAs AVERAGE 350-400k. CRNAs can only make that if they work double the hours of the MDA. 2. I need to see some evidence that NPs in IP states earn more than NPs in non-IP states. I've worked in both groups -- NP pay rates have more to do with rural vs urban than whether or not they are in an IP state. In other words, an NP in a saturated urban area in an IP state makes less than an NP in a rural area in a non-IP state. 3. There are some rumors that the national nursing organizations are going to sue to get NPs paid the same as doctors based on E&M billing codes. If that happens, it will hurt NPs in urban areas, because hospitals will just take the MDs instead if you have to pay the same. The rural areas will always take NPs no matter what because no MDs want to live there.

Go to prison? Yeah right LOL I know an NP in New Mexico where they have 100% independent practice and her title is listed as PHYSICIAN, and she lets people know that she is a PHYSICIAN. She runs her own clinic.

I'm the original poster, and NO I'm not talking about the doctor title, I'm talking about the PHYSICIAN title. It is already obvious that DNPs own the "doctor" title. What you guys didnt know is that LOTS of people use the "physician" title, not just medical physicians. And that means that DNPs can use it as well. In fact, California has already changed their policy so that doctoral-educated nurses are classified as "physicians" in terms of nomenclature. In New York, Dr Mundinger at Columbia is organizing an effort to require New York State to add DNps to the designated list of "physicians" including MDs, DOs, physical therapists, optometrists, chiropractors, and audiologists. ANYBODY who has a doctorate degree and works in healthcare, including DNPs, will be able to use the PHYSICIAN title.

Cut-downs are easy. I worked with an RN at Cooks in Ft Worth who was better than any doctor. They would consult her to do it when they had a difficult access issue.

I think there is a lot of confusion on this board about titles. MDs do NOT own the physician title. In fact, it has been legal for years for a chiropractor to call himself a "chiropractic physician" Pharmacists, DPTs, and anybody else with a doctoral degree can also use the "physician" title. In 20 years DNPs will be able to introduce themselves as a "nurse-physician" and it will be totally normal and acceptable.

One of the comments on the thread caught my attention: "90% of CRNAs work under doctors. If you eliminate that billing, then that means 90% of CRNAs are now unemployed." If this is true then it is a problem. If anesthesiologists cant make money off of CRNAs, then many CRNAs in the big cities where the gas docs are clustered are going to lose their jobs.

I definitely want to know who is treating me, and I expect for everyone to wear different colors. Nametags dont work as many hospital workers dont wear them it seems. RNs, midlevels, doctors, CNAs, medical assistants all need different colors.

BTW, the worst thing about gastroenteritis isnt really the vomiting itself, it is the endless waves of nausea that precede the actual vomiting. the vomiting part actually makes you feel a lot better. The nausea, however, is terrible. I have literally felt like I was dying before. There's been times when I have that nausea that I will punch myself in the stomach or stick my finger in my throat to actually induce vomiting.

Norovirurses and other gastroenteritis viral triggers are mostly spread by fecal/oral contact. HOWEVER, there is one exception. It turns out then when people vomit or stool, a very small amount of the virus particles are actually aerosolized, and anybody who is in close proximity can breathe in those virurses even though they didnt actually touch vomit or stool. How's that for a nice tasty visual the next time you smell someone else's vomit?

I think the confusion in this thread is over what the word "forced" order means. A hospital can, and will, "FORCE" you to do an order you dont agree with by firing you if you fail to do it. Are they going to send you to jail? Of course not. Are they going to put a gun to your head? Of course not. But they DO have the authority to FIRE YOU if you refuse to follow a doctor's order. Doesnt matter if you are a floor RN or a PICC nurse or whatever. Most of the time it doesnt come to that. If a nurse disagrees, then the doctor either does it himself or finds someone else to do it. The doc files a complaint and then the hospital committees have to figure out what kind of action to take, if any. There are many shades of gray when it comes to refusing doctors orders. Everybody agrees that the nurse has a duty to refuse OUTRAGEOUSLY WRONG orders such as giving 500mg of morphine. However, in the more "gray" areas such as this, physicians should get more deference. Whether to place a line or not is a judgment call, there is no black/white, right/wrong answer like there is with the morphine dose. In cases involving "judgment calls" like this, the nurse should ask for clarification first. Most of the time I would argue the nurse should defer to the physicians' judgment on these types of things. Again, there is no clear-cut right/wrong answer, and when that occurs the physician has the extra training to make the final call and generally speaking should be given that deference.

Let me just say that peds oncology generally speaking has MUCH better outcomes than adult heme/onc, the reason being that most kids with cancer dont have other chronic illnesses so that means we can give them extremely high doses of chemotherapy that adults would never tolerate. As a result, there's been a revolution in pediatric cancer deaths. 20 years ago "routine" cancers like ALL would be an automatic death sentence and now the survival rate is in the 90% range. That being said, when you do get the patients that have a bad cancer like AML it is absolutely devastating. Its one thing to take care of a 70 year old with terminal cancer, its quite another thing to take care of a 5 year old who will be dead within 6 months and doesnt understand what's happening to him, and furthermore to watch them slowly spiral towards death. Watching children die is a tough job. Thank god the happy stories greatly outweigh the sad stories, but those sad cases will stay with you forever.

As others have alluded to, there are 2 main reasons this happens: 1) Adult patients with peds conditions are generally covered by Medicaid. Adult doctors dont like Medicaid and a lot of them refuse to see those patients. 2) Adult patients with peds conditions generally make adult doctors uncomfortable. Adult cardiologists for example are essentially coronary artery plumbing experts, but they get nervous with complex congenital heart disease becaues its a completely different animal to them. These 2 explanations account for why we have 25 year olds who cant be transitioned over to an adult service. Its particularly bad for pulmonology, cardiology, and heme/onc patients (sickle cell particularly bad).

MunoRN is correct. The person getting consent should be the one doing the procedure. For blood transfusions, nurses are more qualified to get consent than the MDs are; since giving blood is a nursing, not a physician role. In fact, I've never seen a doctor administer a transfusion except in an emergency situation in a trauma ER or OR.

Of course you guys also need to realize that tylenol is not without risk. Lots of research has come out lately showing that tylenol (which is the only antipyretic you can use in kids under 6 months old) is linked to increased risk of asthma.

Yes, a fever of 100.4 or higher in a 1 month old is certainly a big deal. They will get admitted to the hospital for at least 48 hours. They will get a blood culture, urine culture, maybe a CXR/FA6 if they have respiratory symptoms, a lumbar puncture, and at least 48 hours of antibiotics. However, that has nothing to do with tylenol. We recently had a 6 week old admitted to the hospital with fever of 103. He got all the stuff I talked about but he didnt get a single dose of tylenol during the entire hospital stay because he wasnt irritable, his fever wasnt dangerously high, and he was eating fine. Tylenol is greatly overused in pediatrics. I'd estimate that of all the kids in the hospital who were admitted for fevers, less than 10-20% actually needed tylenol to help recover.