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fuegorama

fuegorama

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fuegorama's Latest Activity

  1. fuegorama

    What the heck is this doctor thinking? Actually not thinking!

    Great explanations above. Thanks.
  2. fuegorama

    What the heck is this doctor thinking? Actually not thinking!

    Dutchgirl. Thank you for your attentiveness and concern for your pt. Without a full H&P it is impossible to deduce the logic here. However, allow me to hypothesize that this pt. is actually benefitting from his/her HTN. The numbers you give are alarming in the standard white, middle-aged normotensive population. This may not be the situation in your pt's case. There is a minority of people who actually require these pressures to perfuse the vasculature you eloquently described in you earlier post. African americans and other minorities can actually suffer "watershed ischemia" from a seemingly mild drop in systolic perfusion. There is substantial documentation of CVAs occuring in situations of a mere 30mm Hg following reduction via antiehypertensives e.g. clonidine 0.1mg. Yes, some of these people live in the mid-200s. I wouldn't recommend it for the majority of us, but these folks do exist. These examples are not limited to blacks, but anecdotally that is the majority. This is just a blind guess, but it may explain "what this doc was thinking".
  3. fuegorama

    Changes in nursing

    As long as there is an Electronic Medical Record that sounds great. If there isn't one at your house please ask for it.
  4. fuegorama

    Changes in nursing

    1.I'd like to see nursing return to a patient-centered focus rather than a nursing-centered focus. 2.I'd like to see the recognition of the profession that what is required right now is clogs on the ground, not two additional years of theory to be "competent" to perform as a RN. 3. Echoing #2 I want to see full hospital and AACN support for AD nursing programs. AD grads perform well and are needed NOW!! 4. I'd like to see a complete suspension of direct route NP programs. E.G. you cannot seek a NP license without five years of verified nursing practice. 5. I'd like to see an iron-clad pronouncement of the limitations of the APN. Where does nursing stop and medicine begin? No mid-level on this board has ever described where they believe the limitations of advanced practice nursing lie. 6. I also would like to see legislated enforcement of ratios. However, if you are limited to 4:1, 5:1, 8:1 respective of your specialty you better do the job. 7. I'd like to see all nurses as independent contract agents. There should be review every 3-6 months with continued employment based on performance. This cuts both ways. The nurse is happy. The facility is happy. That's a short start.
  5. fuegorama

    How embarassing (LONG)

    Full on the above. It's your co-workers who were basically spectating at your situation. You transferred from nurse to pt. when you first reported symptoms/were recognized as being in distress. Cookies make nice-nice, but I hope some of your co-workers apologize for gawking at you during your time of illness. Re: your query. If this is your third episode of SVT why aren't you seeing a cardiologist now? You may need a trip to the EP lab to clear up this recurrent dysrhythmia. ask the Cards guy's advice.
  6. fuegorama

    Yes your highness...I mean doctor!! rant!!!

    I hear ya. It sounds like this guy has some serious pathology.
  7. fuegorama

    Is it true that a BSN will be mandatory soon?

    Why? Can anyone give a cogent answer as to what benefit this will have on healthcare?
  8. fuegorama

    Yes your highness...I mean doctor!! rant!!!

    Aiight- I hear y'all. The doc the OP writes about is obviously a tremendous git that either is carrying a large chunk of the facility, is politically protected enough to continue his behavior, or is treading the floors on his last days. Laughing uproarously at commands like his then leaving the room will get a response you might want to try. I encourage you to speak to nursing mgt. re:what bearing he has on your job. That goes for any facility-based nursing role. Now to the finer points: 1.Standing on the left side of the bed in the presence of an attending is tradition not from some bizarre victorian rule, but from a practical exam perspective. The classic physical exam as taught in medicine is performed from the right. among other reasons for this; most of us are right eye dominant, hepatic margin assessment and 'cross body' splenic palpation is better performed from the right. 2.Fetching gear for docs seems demeaning only if you do not see it as part of your job. Guess what, providing the best care for your patient is your job. A physician's ability to care for that same pt. is dependent on having the right gear. You know your floor and the locale of material musch better than most docs. When he performs a procedure on your patient efficiently b/c you have provided what's required, you are effectively being a good nurse. You may not care, but the doc has a single commodity, his time. A physician's time is really all he has to parlay as a service to multiple pts. Wandering around in the supply room looking for 4x4s is not a good use of his resources. That'll be .02 (actual value .005)
  9. fuegorama

    ready to drop out of FNP program

    Hi- I am sorry you are having such a tough start. Welcome to the mythical world of APN. You are promised the world, but as your post clearly demonstrates, you have not been given the tools to achieve your goals. Learning the practice of medicine takes tremendous dedication. A decent program is terribly difficult while working part time much less while doing a full time gig. I'm sure part of the appeal of the program was the ability to work and learn simultaneously. The reality is fairly harsh compared to the advertisements. Mad kudos for your instructor who is willing to preach some truth. The existence of the FNP is predicated on her cheap wage while 'movin'-the-meat'. Unfortunately, she is correct. There are physicians today, making less than $80,000/yr for greater lifelong sacrifice than what you are going through now. Some suggestions: 1. Float a fat loan. Yep it's financial doom for the short term, but it could mean the diiference b/t your success and failure in the program. 2. Consider midwifery. You have some L/D experience. Those folks can pull down some $$$ in the right environment. It's great work and the rural demand + $$$ makes it a good fit for what you have described as your frustrations. It is also an honest nursing role. 3. Drop it all. Think hard. Do the right thing. Go to med school. Yes it's long. Yes it's hard. But, American medical education is structured to give you what you need. It will require huge loans, but it can still pay, if you choose wisely. Rural? FP? Osteopathic/Neuromuscular medicine in the primary care arena is in demand and will continue to grow with potential for cash reimbursement. You have been lured into a career of false promises with a short cut to independent practice as the carrot. Your current financial and lifestyle reality is the stick. It's a very resilient stick that will come again, and again, and again.... As a fellow nurse/doc-to-be, I encourage you to bail.
  10. This is another viewpoint: http://www.nursingworld.org/ojin/topic28/tpc28_2.htm
  11. fuegorama

    Help me decompress

    Hey there- What you have described is pseudocyesis. I understand how ticked off you must be after rallying to give this woman and her potential kiddos the best shot, but ya gotta know she is one sick not-a-momma. Pseudo pregnancy is actually pretty interesting stuff from a psychophysiology perspective. Many of these women will present with signs of true pregnancy; engorged labia, softened cervix, elevated fundal height etc. (mind driving hormones?) These may be physiological manifestations of a psych issue, or more troublesome, they may be heralds of some endocrine/neoplastic pathology. I am glad you gave your best. I would hope to have that much energy and caring directed my way if I ever need it. (knocking on wood). For true kookiness-check this out http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ProduktNr=224276&Ausgabe=227643&ArtikelNr=49310&filename=49310.pdf
  12. fuegorama

    Doctoral degree to become an NP???

    Thanks and back at ya.
  13. fuegorama

    Doctoral degree to become an NP???

    Caldje- Thank you for your thoughts. You have brought up a practice model that simply cannot be possible. What you propose is a design in which an already fractured system becomes even more splintered. Who do you want taking care of you on your "sick" days? Will it be the person with whom you have a relationship and who knows your history? Or, do you want to go to the most expensive, least continuous form of care we have today, the ED? The major flaw here is the concept that people always know when they are seriously sick vs. NP-level sick as you propose. Sick folks rarely carry that unclean-and-ill sign we all sometimes wish for. I am currently studying for the second step in my medical licensure odyssey. In my question study book I'm seeing about 20% of the questions starting with the stem "a well-appearing _ y.o. _ comes to the office for a well-visit, labs and v/s show________" This is then followed by a list of 5-15 tragic illnesses that are typically asymptomatic at their early stages. This is not just an infuriating device to trip up the medical student. These questions are built around the real deal. The day to day practice of health care. Can an NP see these folks and get it right? You betcha. However, I believe there must be a physician to oversee the not-so-obvious reapers lurking behind that "well" facade. There is also the whole -who can afford preventive care? query. That is a real sticky question. BTW-I went to medical school to be an Emergency Physician. The stand alone NP/DNP (heeeheee) is a guaranteed route for my job security. Not that EPs are lacking business. Your second point that the scope must be well defined is an impossibility with today's advanced practice climate. Midlevels defy any constraints on their practice. Limited prescribing was not enough. Full rights were not enough. Intermittent doc supervision was seen as constraining. Stand alone practice with admitting prileges was still inadequate. Now the very title is up for grabs. I will say again that the AACN will not rest until its members are seen as physician equivalents regardless of ability.
  14. fuegorama

    Doctoral degree to become an NP???

    We each have our opinions on CNA (my abbreviation). This is one place where we will just disagree. This beautifully illustrates the trickle down aspect of medical education. Research and best practice patterns flow majoritively from physician led organizations/projects. Good practice eventually migrates to midlevels who can parrot what doctors perform. The medical community recognized the dangers of overprescription in the 80s. Implementation of these discoveries to practice followed fairly slowly. Educational campaigns to midlevels and the lay public followed. What is missed in the commentary is the use of the script pad for NPs in the first place. Why were so many kids with the sniffles being hit with Amoxicillin? Could it be that when your only tool is a hammer, every problem ..... Are you saying that NPs working in environments where physician oversight is required enjoy professional privileges? If so then we can both make some OJ. If by "collaboration" you mean that NPs in stand alone professional niches are physician equivalents, then I will invite you to share this apple tart I'm fixing.
  15. fuegorama

    Doctoral degree to become an NP???

    [edit at 1109 7/15/06 est per request of mod. i have kept the citations intact in hopes that some readers will take the time to look at these articles. if this is inadequate or continues to violate the tos i would appreciate being informed. thank you.] ok. we are pretty far afield of the thread title and thrust of my position, but here goes. this study has been cited so many times on this and evry other nursing site it now is in real time syndication right after golden girls at 11. that said, it was an eye opener...at the time. this article opened a needed door into a the world of more efficient practice management utilizing a great resource, the np. welcomed by many docs, it ran fairly roughshod over many issues in the debate. let's first look at the disparity in n. the np arm was significantly larger. with greater power, one could assume this would skew the data. this study was performed in an arena of physician oversight. these nps could default at any time if patient needs fell out of their expertise. this is mightily different from the proposals we see today. let us also note that these were the old school of nps. these are the folks who made the possibility of today's profession. multiple years of clinical experience preceding their graduate programs. they were not five semester widgets churned out after their arduous training in english comp, medieval studies or theology. (btw-two of those degrees are held by the s.o. of the best man at my wedding. she is an np) beyond design/reporting flaws, it was written in a different time for a different audience. the study took place 1995-1997. how many of us considered a future where the promotion of the np would lead to an attempted physician equivalence. noting the authors and their institution i think we can recognize a few who saw a zany and scary future. see study below and my bold face above i cannot respond to anything posted from cna. it is a rabidly anti physician site. its position statements are so far outside the sane nursing realm that it defines the lunacy of the dnp debate. 1. this position is one of support for the rational model of midlevel with physician supervision. yay. 2. it is from 1992. once again, today the aacn has attempted to remake the world in its image. ------------------------------------------------------------------------ so here are a few of my own. i sincerely apologize for the c&p but my school's portal doesn't allow external links. i alaso happen to be weary and lazy. apology #2-a large number of articles regarding the np debate are from the uk. who knew? the evolution of the nursepractitioner paula mclaren senior lecturer, school of nursing and midwifery, university of hertfordshire, uk pii s1744-2249(05)00106-3 evidence-based healthcare management nursepractitioners do not reduce general practitioners’ workload brenda leese, bsc (hons) dphil, commentary author reader in primary care research, centre for research in primary care, university of leeds, leedsuk. ☆ abstracted from: laurant mgh, hermens rpmg, braspenning jcc, et al. impact of nursepractitioners on workload of general practitioners: randomised controlled trial. bmj 2004; 328: 927–930. pii s1744-2249(04)00174-3 now some real evidence. as nurses we see the effects of overprescription of antibiotics. the consequences of non-indicated/overprescription of these agents is heavily documented. further, if you have worked in a hospital in the last 5 years you know what c. diff. colitis smell/sounds/tastes? like. 'nuf said. wouldn't you expect the well trained, holistic practitioner to not fall into the script trap? read. differences in antibiotic prescribing among physicians, residents, and nonphysician clinicians. roumie cl - am j med - 01-jun-2005; 118(6): 641-8 from nih/nlm medline nlm citation id: 15922696 (pubmed) comment: am j med. 2006 may;119(5):e21-2; author reply e23-4 pubmed id: 16651040
  16. fuegorama

    Doctoral degree to become an NP???

    Brownrice-Don't give up!! We can still save her. As a student doctor I own my mistakes. Now recognizing the sinister potential of this neoplasm I readily admit we should have started with a massive debulking. This was an error. It is my responsibility to try and inform the family (public) about this mistake and attempt to maintain their trust. We of course can now all see that this is stage IV disease. The central lesion has crossed the midline and now is evident in distant sites of metastasis. There are multiple nodes involved and constitutional signs of tumor secreted hormones. Yes she has a beard and hyposmotic urine, but these are not reasons to give up on novel modalities. We will return with surgical intervention. (see the AMA initiative above) Chemo will begin in earnest. (must liquor up state legislatures) Most importantly, we must maintain a sense of hope. As an osteopath I have tremendous trust in a body's ability to heal itself with proper guidance. Call/write/petition the AACN and purge this evil from the body. I am always here for a consult.
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