Parsifal

...and the truth shall set you free!

#1 Nurse practioners are unable to prescribe or diagnose without the collaboration/cooperation/ of a physician (they work 'under' and are dependent on doctors to 'grant' them this 'mid-level' autonomy. (again...nursing 'profession' dependent on a different profession... ) #2 the only truly autonomous decisions a nurse can make regarding the care of the patient are concerning hygeine and safety. Are you suggesting that we're professional 'advocates'? Without a doctor giving/agreeing to 'orders', you can advocate all day...but would be unable to care for a cure someone...outside of hygeine and safety. ...just like a CNA. You dont need a degree to be an advocate. And those nurses that work outside of acute care...still need doctors orders. I would like to hear someone 'testify' as to how they dont. (outside of the said hygeine qand safety stuff)... Asystole... c'mon just give in. Once you face this realization you can begin to heal. The truth sometimes hurts..

Caring for a septic lady in her 30's alongside a young-ish new ER doctor. Patient very sick with multi-organ involvement. Just intubated, central-lined, vasopressors, etc. Was given two amps bicarb prior to/during intubation (unable to obtain ABG's prior to intubation d/t poor perfusion/pulses etc., but bicarb/CO2 by chemistries was 9) 30 minutes after intubation ABG's show a pH of 7.0. Bicarb of 13. Base Excess of -15. I approach the doctor... Me: " Hey did you see the ABG's?? You want me to give any more bicarb?.." Doctor: "...No...(waving his hand at the results rather off-handedly) ..this is all metabolic...bicarb wont cure anything..." Ummm. How would you respond to this? (true story...true conversation...true hand gesturing)

'Professional' nurses are unable to practice their 'profession' without being overseen and directed by a different and entirely seperate 'profession' (doctors). Any talk of nursing autonomy/independence is simply an illusion. Any nurse deluded by such illusions runs the risk of practicing medicine (a profession) and losing her 'professional' license. Perhaps at the most basic level a nurse could independently care for a patient's hygeine and safety...but so can CNA's...etc...who are in no way considered professional by the 'truly' professional nurses. (However, CNAs COULD be considered professionals if CNAs went to school for four years and developed CNA theories...oh wait...those theories already exist...in the form of nursing theories...sheesh..)... At any rate, this dependence on another profession is unique among 'professions'...and a glaring example of the true nature of our 'profession'. *we practice with and through doctors orders. Without them, we are mere hygeine/safety technicians...with a degree* Lastly...maybe if they werent called doctors 'orders'...perhaps doctors 'requests'...or doctors 'suggestions' they'd be easier to swallow. The word 'order' just speaks to the paternal origins of the doctor/nurse relationship and is a pet peev of mine. And also...my use of 'profession/professional a million times in my post was a wee bit of self-serving humor. Sorry.

A simple answer to this could be that this 'septic' patient was on antibiotics. This is often an overlooked cause of elevated INR. Some ABTs are actually more likey than others to cause this (cipro is one that sticks out in my mind).. And the reason ABTs do this is actually quite simple and easy to understand. One major way our bodies acquire vitamin K is that some of the normal flora/bacteria in our colons/GI-tract produce it. (yuck). Wipe out this beneficial bacteria with ABTs and patient loses this source of VitK... INR can elevate. Sometimes its as simple as that.

Hi. Just curious and hopeful someone here can lend a bit of insight. I will be applying to an FNP program in the coming spring...and was curious as to whether i should pursue a different position at my current place of employement. My background is primarily critical/cardiac care (~10yrs in an ICU, ~4yrs cardiac step-down prior to that). Currently (the last year), i am working in an electrophysiology lab. The EP-lab is highly specialized and as a result i see only a focused/select patient population. So...my question is this: I'll potentially be involved in the FNP program for 4 years (ill be part time). Would it be in my best interest to move to (for example) an ER-type environment...in order to see a high volume of 'office'-type patients/experiences? Or do you beleive my decade of critical-care experience would be adequate and/or relevant to FNP? My hunch is yes it would be beneficial to transfer to an ER...but my current work schedule is *sweet* and i'd be bummed if i had to jump back into shift-work and weekends. Thanks in advance.