SnowShoeRN

I agree that sometimes MD's need an ago stroke and can often be intimidated by us as nurses. A tactic that has worked for me (once I've called a MD or confronted him/her directly with a questions) and was subsequently yelled at or gotten made to feel stupid is to take a deep breath and say something like "I see. Well, in the future, when *would* I xyz?/give these medications/call you for clarification/etc?" Or "Can you help me to understand why xyz instead of abc?" It presents an opportunity for learning and makes it seem like you aren't questioning their judgment, but are instead eager to learn from their all-encompassing wisdom. I have had the fortune of having the vast majority of my interactions with MD's be positive. When the above hasn't worked for me (and sometimes even if it has) I let things cool down a little and then approach the MD directly. If that doesn't work or their behavior continues I go straight to the attending, my manager, and/or the director.

Thanks. :)

Wish I could access the link...

Good article, but the last paragraph leaves a bitter taste in my mouth: "I wish I could say otherwise, but after being publicly slapped down, I will think twice before speaking up around him again. Whether that was his intention, or whether he was just being thoughtlessly callous, it’s definitely not in my patients’ best interest." I think it's in everyone's best interest to elevate the level of professionalism that nurses hold. And if we can't speak up for ourselves, how can we be expected to be good advocates for our patients?

Awesome! Thanks for that! :) Actually, shortly after I posted this question I came across an old post from 2008 about how there were NP's in Australia. The thread linked to some youtube videos about NP's in Australia and I got a lot of my questions answered. I still doubt they would take me without any NP experience so maybe I'll be waiting another 3-4 years or so, but that's okay. At least now I know I could work there! Thanks again.

Hi guys, So I've been trying to get back to Australia (spent 6 months of uni there in 2002) for years now. I've been a nurse for 5 years and was actively looking to return to NSW for nursing last year. Except life got in the way and now I've hurt my back with plans to start grad school (here in the states) in the fall. I'm hoping that once I finish my Masters of Science in Nursing (MSN) and become a Family Nurse Practitioner (FNP) I can FINALLY go to Australia to work. At least for a year or 2. My question (since I'm hoping to soon leave bedside nursing behind me due to my back injury) is "Does Australia have anything that would be the equivalent of a Nurse Practitioner in the US?" That's badly worded, but I hope it makes sense. I have known a few people who have worked both in the US and Oz (Australians and Americans) and it seems like the general consensus is that nurses practicing in Australia seem to have less autonomy than in the states. What are your thoughts? Would I be able to get a clinic job as a NP in Australia and/or practice relatively independently? Are there any nurses in Australia with 'script writing privileges? What kind of work *would* I be eligible for with a MSN? Are there any American NP's reading this who are practicing in Oz now? Any input would be greatly appreciated. Thanks. :)

To the OP, it sounds like you used your best judgment and that was a good call. On our unit, we don't even have techs monitoring the ...well...monitors. :) It's us nurses who have to keep a look out for our patients and each others'. And the dilt/cardizem gtt patients are always being watched FIERCELY. It's kind of an unspoken policy on our floor that once they have a heart rate consistently in the 70's, the gtt gets turned off. (Incidentally, I have no idea why someone would order a dilt gtt for a pt whose HR is 68...) As for patients vagal-ing out, that's happened to us too. Most of the time we don't let even our dilt gtt patients get out of bed to urinate or defecate. We've just found their BP's and HR's to be too labile.

Like the one guy who says something like "A man had sex with a mosquito?" Priceless..

When putting on a gown, mesh panties, whatever, saying it in an encouraging enticing tone, as if I'm trying to sell it, "This is one size fit's no-one..." A nurse said it to me once when I was a patient and I've used it since. Never fails to get a laugh. :) When taking a social history being sure to ask everyone, especially the old ladies about their smoking, drinking, drug history. "No marijuana? No crack cocaine?" If they or their family laughs or are surprised and smile I just go on, "Not dropping acid in the park after church on Sundays?" Soon the whole family is laughing. Incidentally, I've discovered that it is a valuable question to ask. I do still get the occasional 70-80 year old say "Oh yeah. I smoke pot maybe once a week" or whatever. AND...I'll never forget this... I had a 97 YEAR OLD lady say to me once (in reference to marijuana) and after a pause to think about it..."No...but I've wanted to. It's such a pretty plant. My grandson..." Laughing, I stopped her there and just made her promise not start while she was in the hospital!

That's not really funny. But it's kind of really funny. :) I hope they are both recovering well. Articles like this fascinate me. Biology and Medicine are so cool.

Gotta agree with surferbettycrocker on this one. Excellent points. Higher acuity does not *always* mean less patients and more time to chart and/or spend with patients. The thing with cardiac and/or med-surg tele is that we *do* get the patients who have both general med-surg concerns AND a cardiac complication (or 2 or 3 or 8). Whereas, perhaps, floors exclusive to cardiac surgery may be less likely to get patients who have originally been admitted for something else entirely. ICU is another story. Nurseraven, I've worked both med-surg and cardiac/step-down but never ICU. I basically stand by what I said in my response to the OP and also what surferbettycrocker just said. As for your thought: ".....And also, i have a feeling that higher acuity units are not physically as heavy as general med-surg wards. So nurses get more time to do their actual nursing assessments..." The reason nurses get assigned less patients on higher acuity floors is because the patients' needs are more numerous and/or more complicated. 5 med-surg patients may easily equal 2 ICU/Step-down patients in terms of time spent with the patient doing the education, med-passing, dressing-changes, and assessments. Not to mention charting. Med-surg is a great place to get your feet wet, so to speak, but it's hard to say that this floor or that floor will always be harder or busier or whatever because that depends so much on the patients, staffing, and general area. I've had relatively easy shifts on cardiac and really hellish shifts on med-surg. But, in general, my cardiac/med-surg tele assignments have usually been busier and much more complicated for me.

Thanks for that. I wish we could delete posts after they'd been made because someone private messaged me the answer to my question only a few days after I had posted it and I just forgot to get back to the thread! Oh well. I've since spoken with a bunch of people (professors, admin people) affiliated with programs at a few different schools to get more info as well. Thanks for your response. Question has been answered, everyone. No need to post anymore responses. :) Thanks again!

Yay! :) Congratulations!

To whom is this question addressed?

Joe, I love your screen name. :) I agree with pretty much everyone above. Our floor gets mostly medical cardiac stuff: MI's, CHF, TIA's/CVA's, serious arrhythmias, and sometimes pacemaker placements or 1 or 2 days post-cath. BUT...the interns routinely think we're a step-down unit and most of our patients have pretty serious co-morbidities so in many respects we may as well be. We have a lot of back and forth between us and the ICU in terms of patients coming and going between us and them. And when patients on the other med-surg floors start to go bad, they're usually sent to us first. By our hospital standards, we have a very high turn-over as far as patients coming and going. It's not unusual for us to get 5+ transfers/discharges and 5+ transfers/admissions in the course of an 8 hour shift. And yes it's much busier, and in many respects "harder", but I think it's an excellent way to transition to ICU. And as you find yourself becoming more experienced in nursing I imagine you'll be interested in challenging yourself more and more. :) My one piece of advice is to find out about their staffing ratios. It sounds like a very fast-paced high acuity floor. But nothing can kill the happy adrenaline buzz quicker than finding out that instead of 2 or 3 patients with massive pain control issues and Q15 min vital signs, you're getting 5 or 6 patients with massive pain control issues and Q15 min vital signs. Best of luck with your decision.