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platon20

platon20

Content by platon20

  1. platon20

    MDs dont own the physician title

    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.
  2. platon20

    MDs dont own the physician title

    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.
  3. platon20

    MDs dont own the physician title

    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.
  4. platon20

    low glucose baby, NPO, no access to dextrose

    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.
  5. platon20

    "Anesthesiologists are gaming the system"

    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.
  6. platon20

    Score one for standardized scrub colors

    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.
  7. platon20

    Norovirus

    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.
  8. platon20

    Norovirus

    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?
  9. platon20

    What to do about refusing Dr. orders?

    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.
  10. platon20

    Pediatric Oncology

    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.
  11. platon20

    adult patients admitted to a pediatric hospital

    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).
  12. platon20

    RN obtaining Consent for Blood Transfusion & PICC lines

    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.
  13. platon20

    Calling all peds/ER nurses RE: Tylenol dosage

    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.
  14. platon20

    Calling all peds/ER nurses RE: Tylenol dosage

    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.
  15. platon20

    Calling all peds/ER nurses RE: Tylenol dosage

    I almost never order tylenol because a fever is not that big of a deal unless: 1) child is so irritable he refuses to eat or sleep (if he's really that irritable you can make a strong argument he needs a lumbar puncture and antibiotics) 2) fever is outrageously high (rectal temp 105 or higher). Those are really the only indications to treat a fever IMHO. If a 1 month old baby has a fever of 102 but is sleeping fine and eating OK, there's absolutely no reason to treat it with tylenol. The pattern of a fever can be a great diagnostic clue as to whats going on, and if you artificially suppress it with tylenol it can sometimes make the diagnosis harder.
  16. platon20

    Can NPs write fertility drugs?

    The only NPs who should be writing scripts for fertility drugs are those who work with MDs who specialize in REI (reproductive/endocrine medicine) who have special training beyond the usual OB/GYN stuff. IN that context, yes, NPs can script for clomid. However, it is GROSSLY IRRESPONSIBLE AND BORDERLINE NEGLIGENCE for anybody other than somebody who works at an REI clinic to script these drugs, that goes for both MDs and NPs. I would NEVER allow a family practice NP to script these drugs, just as I would never allow a pediatrician MD to script them either. Its dangerous and foolish for those without special training to get involved.
  17. I dont think its fair to judge all doctors based on that one thread. I will say that Obama picked a poor example to highlight the importance of nurses. He basically said that the doctors were irrelevant and only the nurses provided anything useful which is total crap. A kid w/ bacterial meningitis who receives the best nursing care in the world will die without a doctor's intervention. My point is you need both doctors and nurses. I think Obama was simply catering to his audience. If it were a group of doctors there, he would have gone on and on about how the doctor did the LP, diagnosed meningitis, and saved his daughter's life. My point is that he's a typical sellout politician who will say whatever he thinks makes the audience happy.
  18. platon20

    Is The Doctor Missing It? Stepping on Doc's Toes

    No, this is inappropriate. Nurses cant/shouldnt be calling physician consults. The only exception would be for a crashing patient who needs an ICU doc to assess for possible transfer to the unit. Calling a endocrinology consult for a patient with poorly controlled diabetes is the doctors' job, not in the nursing autonomy/scope of practice. Your job is to document the pooorly controlled sugars and that the primary doc is not addressing the issue. Later you can try to talk to the program chief or head of staff; but calling a consult is out of the question. P.S. High blood sugars is RARELY cause for an urgent consult in the middle of the night. Most endocrinologists I know would be ****** off if they got paged at 4 AM because a known diabetic has a sugar of 500. They'd be happy to add on a sliding scale regimen or increase Lantus dosing in the morning.
  19. platon20

    Difficult Doctors...Vent

    No, this is inappropriate except in circumstances where a patient needs an ICU bed and the primary doctor wont call you back. Only in that circumstance is it OK to call another doctor (ICU doc). I agree with this; best way to go. NO, this is not acceptable. Nurses cant and shouldnt call for physician consults. A consult is specifically a physician to physician deal. First off, a specialist wont get paid for a consult thats called by a nurse. Secondly, most specialists would be rightly angry at a nurse calling a consult, ESPECIALLY in the middle of the night. Thirdly, consults generally require knowledge of pathophysiology that nurses dont have. If a nurse called a nephrologist in the middle of the night with a chief concern of "this patient is oligouric/anuric" thats not very helpful information in and of itself. Its incredibly rare that you need a nephrology consult in the middle of the night, even for a 100% anuric patient. Dialysis can usually wait till the AM, and nurses arent qualified to know when someone needs emergent dialysis or whether they just need conservative management until the primary doctor can talk to the specialist in the AM.
  20. platon20

    We may need fewer nurses in the hospital...

    Ummm, a midwife is not qualified to take care of babies outside of the immediate resuscitation window after birth.
  21. platon20

    We may need fewer nurses in the hospital...

    Umm, trust me you dont want that. Doctors already spend ungodly hours with paperwork for reimbursement. Do you really want to work your 8 hour or 12 hour shift and then go home and do paperwork all night long to "bill" for your services? Because thats what you would have to do. Medicare/Medicaid/insurance companies are built on denying reimbursmeents. That means they come up with ridiculous paperwork hoops you have to jump thru. So just charting that you "placed an IV on Mr Jones" wont get you reimbursed. You'll have to do ridiculous things like record the lot/part # of the IV tubing you used, document a medical code as to why you put the IV in, document which meds and doses were needed for the IV, etc. What you think is a 5 second scribble to get reimbursed just turned into a 15 minute pain in the ass paperwork procedure to get paid maybe $5 for doing an IV.
  22. platon20

    nurses intubating newborns

    I could see the occassional transport RN intubation, but transport RNs doing PICCs? Thats ridiculous. Do they do chest tubes too? The transport RN's job is to stabilize infants for TRANSPORT, not to screw around w/ PICC lines. If they are holding up the transport to the NICU so they can put in PICC lines then they are providing poor quality care. A PICC line is NEVER an emergent issue that has to be dealt with during transport. Our level III NICU has residents and fellows that do 99% of all intubations, PICCs, UVCs, UACs, chest tubes. Its rare that a transport RN does an intubation, but I've seen it happen once or twice when the baby somehow gets extubated during transport. But those situations are few and far between. Frankly someobdy that only does 1 intubation every few months is not qualified to do them. You need an experienced provider to do so.
  23. platon20

    What is so wrong with discussing end of life care?

    I see a lot of accusatory/angry posts on here about how its all doctors fault as to why people are kept alive for so long. I think you guys are way off base. The reason doctors keep people alive is not because they are trying to make as much money as possible or to give residents "extra" training. Its because the DEFAULT mode is to keep people alive as long as possible unless the family/patient says NO. However, in order to get patients/families to say NO to further care is a very long and involved process and its not easy to do. Most of the time in order to get families/patients to withdraw care, you have to give them absolutes. You have to tell them "you will not survive this, there is zero benefit to doing this procedure." Instead of saying that, most doctors will say something to the effect of "you may die, but we dont know for sure." When you say that, the DEFAULT position of patients/families is to say "well since you dont know for sure then lets just keep doing everything." Consider the possible case scenario. 80 y/o man with stage IV osteosarcoma comes in with a major heart attack, asystole for 10 mins before being shocked back to "life" now he's on a ventilator. Doctor #1: "There's no chance of survival. Nothing we do will change his outcome. We should withdraw care" Doctor #2: "He will probably not survive this but we dont know whats going to happen yet. We can do X, Y, and Z if you want but it may not help." I propose to you that Doctor #2 scenario is FAR more likely than doctor #1, because it is very uncomfortable to speak in absolutes. Would you nurses agree with the assessment of doctor #1 if it was your father? Or you would you think to yourself "hey I've seen guys in worse shape than this survive before, this doctor doesnt know what he's talking about." There are thousands of doctor #2 for every doctor #1 out there, because it is virtually impossible to speak in absolute terms about imminent death and survival odds. Given that, its easy to see why the "default" path is to just keep doing stuff for as long as possible. There's a lot of uncertainty in medicine, and that carries across into end of life discussions. Its not as easy to convince a family to give up life support as you guys think it is (that is unless you are willing to use absolutes)
  24. platon20

    Karmic Justice for Winkler County Nurse Doctor

    The reason doctors get away with malpractice is because they can afford dirty lawyers who will sue the medical board any time they get sanctioned. As a result, the medical boards only move against doctors if the evidence is absolutely overwhelming, and usually "simple" medical malpractice doesnt cut it. You've got to rape patients or kill them directly. There needs to be a change in law that gives state medical boards more protection from lawyers and you will start to see them hammer down more of these idiot docs. Texas is a big state -- I seriously doubt that the people running the medical board have any idea who this "cowboy" in rural Texas is or what he is up to.
  25. platon20

    Over riding a resident?

    I agree with #1, not with #2. There are 2 occassions where a nurse should question a doctor's orders: 1) when its unsafe; 2) when its an obvious oversight or duplicate order. The scenario described by the OP fits neither of those scenarios. Its not like the resident ordered a heparin drip for musculoskeletal chest pain. THAT is an unsafe order and needs to be questioned. Doing stat troponins, CXR, EKG DOES NOT HARM THE PATIENT AND IS A VALUABLE DIAGNOSTIC WORKUP, therefore it should have been done, as ordered. You are ABSOLUTELY wrong here, and it illustrates the trouble that nurses have when they think they can replace the thinking of doctors. While its true that chest pain should be evaluated in person by a doctor, there are studies showing that musculoskeletal chest pain vs ischemic chest pain in post-op patients cant be distinguished very well by most patients. Therefore they deserve a basic workup. As for troponins being "worthless" in OHS cases, again you are absolutely WRONG on this point. Of course they are going to have elevated troponins, but the TREND in troponin rise is critical. Lets say you have a pre-op heart patient with troponin of 200. Post-op, it rises to 500 due to myocardial injury from the procedure. Then, it will commonly start to drop off slowly, maybe 2 days post-op its down to 250. Then the patient c/o chest pain on POD #3 and the troponin level is back up to 400. Are you honestly going to sit there and ignore the troponin level because you say its "useless" in OHS cases? Thats absolutely wrong logic, if post-op troponins rise at hte same time the pt is c/o chest pain, then you have to assume that they are having an ischemic event post-op that needs to be managed. Again, to say that troponins serve no role in the post-op care of OHS patients is ridiculous. Thats something that DOCTORS, not NURSES, are trained to address and you are wrong for thinking you have the knowledge base to make that decision. Thats no justification for ignoring the order. If you are getting swamped by critically ill patients and cant keep up with them all, then its your responsibility to notify the charge nurse and have somebody else help you out. You cant in good conscience say "I'm too busy with my other patients to deal with this patient who could be having a life-changing ischemic event."
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