laurentrilli

Doing exams this quickly may be "efficient" but the patient is getting a lousy exam. "rescheduled if late even if prepped"? that shows a callous disregard for the patient.

my 2 cents worth: I just had a NP do my annual physical and she was great! I'm not easily impressed; I'm in med school, the oldest in my class. if I ever go into primary care, I hope that I'm as good as the NP that did my physical. is she a doctor? mo, but she has a doc to back her up. and let me tell you this: most MD's are less than enthusiastic about treating "routine", boring issues like HTN, obesity (I'm overweight) etc.....I work with a PA (surgical) and NP's (last rotation). I'm happy that a NP is basically in charge of my health...........

You asked for opinions, I'm a med student (oldest in my class)..propofol is an induction anesthetic and should only be administered by anesthesiologists..nurses SHOULD NOT administer this drug. Personally, I would not be comfortable with a nurse (CRNA) doing my aneshtesia; I specify an MDA for safety. When I was a nurse, I thought that CRNA's did a great job; now that I have had a LOT more exposure I want an MDA doing my anesthesia, sedation etc..................

I asked a similar question in my post "lower endoscopy usual practice". I discussed conscious sedation practices for colonoscopy and I was surprized at the opinions that I got; I was mainly interested in unsedated exams but got a lotof info on propofol. The Chief GI doc said that patients overwhelmingly preferred propofol to the benzo/narcotic combination, but they didn't do many cases with propofol because it required a CRNA to push it and that added an unreasonable amout of money to the bill. He also said that it was often difficult to keep things on schedule because they were constantly waiting of the CRNA to show up to administer the drug. What surprized me was his opinion that a patient deeply sedated (ie with propofol) is more likely to get perforated that a lightly sedated or unsedated patient. Nurses are not permitted to push propofol in our hospital; a while back one of the CRNA's was telling me that the new drug fospropofol may be approved to be administered by non-CRNA's...which makes little sense to me since fospropofol is metabolized into propofol.

I'm trying to get a handle on how different endo departments deal with colonoscopy patients who request an drug-free exam. Our hospital's endo department has a lot of differing opinions on the matter. One doc said its an uncomfortable but better/safer exam..ie: the endoscopist has to go slow and the patient can feel pain before getting perforated (which is a big safety factor). Another doc in the same department says an unsedated patient makes them rush to minimize the patient's pain so unsedated is a bad idea. I know that a lot of patients prefer deep sedation with propofol because the exam is basically pain-free; some patients report discomfort with the usual midazolam/fentanyl combination. So it seems to me that the risk of perforation is increased with a deeper degree of sedation since the patient can't feel when the scope is looped; from the standpointof safety it would seem that the safest exam would be drug-free, followed by midazolam/fentanyl and propofol would be the least safe (the reverse order of most patients preference). I would appreciate anyone's comments. Thanks.

Sugarbush-I'm sure that you are correct. Handing out titles such as Dr. to everyone is meaningless; ask the pharmacy profession; did anything change when they went to the all PharmD degree many years ago? Nope, it just meant that pharmacy school got one year longer. Most pharmacists still do the same jobs. CRNA's are on track to be a doctorate program; nothing will change....except the schools will make more money. I'll eat my hat is an anesthesiologist (MD) ever addresses a CRNA (nurse) as doctor and considers them to be a collegue rather than a "worker".

The university medical center that I'm affiliated with pays the same rate for ADN and BSN; at least on paper. And that's fine if you are satisfied with working the floors, but if you want to work on one of the specialty units like same day surgery (and enjoy a much better schedule, no weekends or nights) then you had better get your BSN because you won't get hired to work there. We have been offered almost 100% tuition reimbursement for nurses who wish to return to school and it's disappointing that many aren't interested (and some probably can't afford the time); but the writing is on the wall: if you want to advance or work a specialty unit, you need to get your BSN.