The Attack on Nurse Practitioners...Is It Warranted? | Against Medical Advice 014
Вставка
- Опубліковано 17 чер 2017
- When a silly meme unleashes a torrent of #butthurt, it's probably time to talk about physicians versus nurse practitioners and why there's so much drama. A complex discussion, watch the whole thing before you get triggered!
incidentreport.co - Комедії
Nice video 🥰🥰🥳your video is so cool, honestly AANP is such a difficult test man , really don’t know what to do but I’m never losing hope.
At times it doesn’t matter how hard you study you also need to pray to God for success.
very correct .
I have a cousin who never studied much, we studied together but she gives most of her time to her phone than studies after writing the AANP test last month she passed and I failed 😣, I asked her how she did it , just found out she got her help from Mrs Brenda.
wow so sorry you failed , I have heard so much about Brenda but I don’t actually have her info .
Thieves now pretend to help you pass and they end up taking your hard earned money, Brenda is a sure help but very difficult to get her info.
I am an FNP in an Urgent Care clinic. And one thing mentioned (I literally paused the vid to comment) was he found early onset stroke or early MI vs GERD.....I started as a CNA, then LPN, ASN, BSN, MSN with post grad cert of FNP. Mind you I have 21 years of “plain” nursing under my belt including 6 years in Med/Surg, 4 years as a Charge nurse in OB/ Labor, Delivery and Post Partum and Newborn Nursery, 4 years Charge Nurse in ICU, and 7 years of ER nursing with Trauma Certification as well as all the required PALS, BLS, ACLS, etc etc. As an NP, I too have diagnosed MI over GERD, TIA, Stroke, Kidney stone, the list goes on. This is at an urgent care where we have NO radiological CT benefits. No quick turn around of stat labs. This is pure assessment, physical findings, and 21 years of training. I feel Nurse Practitioners are a vital role to the medical community (as are CNAs, Nurses of all varying degrees, MDs, NPs, PAs, Surgeons, etc.) and I know these two support the whole system as well. I just wanted to point out it doesn’t always take a doc to suss out something critical. I don’t just diagnose STDs. For example, I had a guy with “difficulty swallowing”. After my assessment of him I set him up for an EGD. He ended up having an aggressive throat cancer that was caught just in time and he is expected to live a long healthy life and the cancer is gone (after much treatment of course). But as an NP it’s like people expect you to just say “oh it’s strep or reflux or your thyroid”. Some of us DO know how to do a comprehensive assessment and listen to the patient and match it to the history and our physical assessment and get these people to the proper specialists if need be.
Ok, rant over :) Just wanted to back up those of us who aren’t doctors but are still kicking some serious ass and helping so many people.
People don't understand how it all works and how difficult without further labs or xray to do really narrow down all the differential diagnosis.
Youre not getting it. The problem is that NPs like you, want patients to view you as a physician. Youre not one and just because you can independently practice doesnt mean you can always provide similar care. Please dont go around telling your patients to call you doctor. Tell your colleagues the same thing too.
mike school if I spend a century and half in post-grad to earn my doctorate than by the lord I’m gonna call myself a doctor and neither u nor anyone on gods green earth can stop me. This DOESNT mean I go around introducing myself as an MD. I would present myself as Dr. x, Nurse Practitioner. So you can stop being butthurt about it now. :)
@Yhu Nmhe so u want to mislead patients because of ur ego. thats terrible.
What you said about diagnosing throat cancer as strep throat sounds more to me like the experiences of people I know had with Doctors. I'm a nursing student and a hospital CNA and a future NP, and I admire your experience.
Associates degree for RN is actually 3 years full time with hundreds of hours of clinical. The ASN actually has more clinical than the BSN.
@Truly Blessed 16 months! Where is that?
I got my nursing degree at a university in the Philippines for $500 You just get to download your diploma and that’s it! Easy Peasy!
@@CJGfarm by time get thru chemistry and a+ p other prerequisites etc ...but I'm in decades
@@Greg_P611 no wonder it's getting a bad rap
Also the BSN only has one more class of pathophysiology and assessment. The rest is just bullshit and filler.
The research class is also good but that’s it.
There is no excuse for anyone in healthcare to treat a fellow healthcare provider with disrespect. As an RN, I suspect that one of the reasons the nurses that staffed Stanford hospital during the strike were nice was that they were being paid extremely well to be there. Travel nurses make really good money...$40-50/hour in extra pay would put anyone in a good mood.
Nurses, Doctors, PA's, NP's are all guilty of bullying, within their ranks, and of each other. I have noticed, however, that it tends to run in groups. It seems to be in certain areas or floors within hospitals. As a nurse, I can only speak to what I see, and I have seen in my 33 years, that the nurses who are seen as leaders on the floors, are the ones who set the tone. If they are negative, and critical and bullying, then it spreads to all the staff on the floor as the new staff learns from the old. I have seen where ONE PERSON can change that tone. All it take is one of us to look up and say, hey, that's not appropriate or necessary.
When I worked at a training hospital, the nurses looked at the new residents as their responsibility to make sure they learned to "do it right". ie: make sure they got all the right orders in, (please don't forget food! lol) but the TONE they used, again, really set a lot of how the doctors viewed nurses. Some floors were led by harridan's who seemed to take great delight in ridiculing new interns.
The bottom line is, that it is up to us, and ONE person can so make a difference.
My cousin who is a NP was picked on by some MDs and it was not cool... I know my cousin does not dare call herself a doctor. Sad
So if an NP is midlevel then that means that as an RN I must be viewed as a "low level." The NPs and CNMs that I have worked with do not confuse themselves or patients that they are doctors. They don't want to be doctors, that is why they chose their path. It's very frustrating to see so many doctors put them down and actively interfere with allowing them to practice to their scope. One important point is that many NPs have been RNs for many years and have learned how to note those subtle signs and symptoms. As an old ER nurse I really do hate July. I have so much pressure from admin, patients, and families to move move move patients through. And then I have an unsupervised intern who is physically blocking me from assessing a patient and starting the blood work - with the attitude that I am a lowly nurse and I need to leave until the doctor is finished. And then I get nastiness from the attending for not having blood work submited and returned in time. On the other hand I love the interns who want to work together! We work together, we move patients, I share tips and tricks, I teach them all of my IV secrets, etc. Bottom line is that I could write a book on the bullying, egos, eating of the young, etc. It's a complex issue with a simple solution: don't be an a-hole.
RN is viewed as low level. Many NPs, CRNAs and PAs want patients to call them doctors and want the respect of physicians. Just because you havent seen it doesnt mean it doesnt exist. Nursing and PAs are pushing for more autonomy because of this reason. An NP is not on the same level as MD/DO. They are generally inferior.
@@mike112693 Well that's so super sad since nurses spend so MANY hours with patients...it's sad how society see nurses as low level. It make me truly sad...it's another way of saying nurses are truly underappreciated. This could throw off people from being a nurse. Everyone deserves respect not just physicians.
Nurses should never be looked at as "low level". Nurses are backbone of the healthcare system. I owe a tremendous amount of my training to working with the RNs and learning pearls of how to work in the hospital. If anything, RNs are what give NP's any credibility. The NP training is so beyond inferior and leads to a tremendous amount of error. The problem I have is the lowering of standard of care by the large volumes of NP's being produced and marketing themselves as "experts", "specialists" and wanting to be called Doctor, often practicing out of scope. My observations working with them are not meant to bully but an eye opening that I would not want a loved one to be seen by someone with substandard training. The scariest thing is seeing them practice without knowing what they don't know.
Thanks for this video, you two! I am a nurse of 33 years--with most of my career in ICU, ER, and Flight. I started teaching 15 years ago (and during most of that I continued to work at the bedside) and I earned a PhD along the way. (and by the way, I shun the title, "Dr." as a frivolous academic title--and do not use it. Probably because I worked in a hospital for so many years and see that as 'posing' , not to mention confusing outside an academic setting).Anyway, I am now going back for an FNP--online. My clinicals, however, will be on the ground and I anticipate my learning curve will be steep and uncomfortable. I have no delusions of wanting to be a doctor. I respect doctors as colleagues, and I respect their knowledge and honed expertise. I recognize, however, that I have some expertise and knowledge that I can bring to the table, too. My desire is to work at the top of my license in collaboration with MDs (not in competition with them!
I love this video. Thank you for another needed nuance take from you and your wife. So happy to see your family flourishing. I am worked as RN in community health center, and am an FNP (in person school for 3 years), and now currently working on my PMHNP cert (online at an Ivy Plus school led by physician faculty that teach at the Medical School and it is rigorous) with clinical rotations that should have more hours tbh. The program quality all depends and I can see the concerns but in practice one would see there should be concerns of practice from all the different types of clinicians. I appreciate this 3.0 model where we learn from each other rather than fight each other. Thank you for fighting this important cause for the sake of our patients, ourselves, and loved ones.
I am a BSN nursing student who is the daughter of two medical doctors . It is VERY evident the different priorities between the MD mind and the priorities of the Nurses mindset. It is funny to realize it now that I'm learning the nursing model after growing up with these super high pressure MD personalities LOL. My Mom and Dad truly respect nurses and LIKE that there is a less paternal and more collaborative mindset in the "new blood" of healthcare. I can't recall how many times my parents have told me they have learned a lot from nurses over the years. With regards to Nurse bullying, I have ZERO ego when I'm in clinicals, I get it cause I know nothing LOL. There have been several times some snarky nurse wants to try to snap at me. I just kill her with kindness - and usually she backs off and ends up being a wealth of knowledge and support. It is amazing how respect and kindness will transform the biggest RAGEFACES into your TEAM. Healthcare needs to lose the fragile egos. Egos like hairdos!
As a brand new RN(2017 grad) and as a paramedic with 15 years experience AND as a older man who came into the nursing field late in life (finished school at 50 yo). As a medic there is quite a lot of bullying that is unfortunately in grained in the system, but it is getting a lot better. My experience with bullying in the nursing field is very limited and honestly I have not seen very much of it. I did have one older RN that tried to "bully" me by telling me to go get her coffee, and just shut up when I was following her during my training. I told her that I am not her slave and that I as a new RN will ask questions when it is proper to do so, obviously not when we were busy. But I stood up to her and did not back down when she attempting to brow beat me and stare me down into submission. After that incident I did not have any problems, and to be clear that nurse did come up to me later and apologize for what she did and say. Other then that all my interaction with all the levels of medical staff has been pleasant.
I don’t respect people that I have to stand up to. They should not attempt to bully to start with. What a jerk
Thanks for this video! I have been in a FNP program for 1 year, I still have about 18 months in online program. The program I am in is extremely challenging and time-consuming and requires scholarly discussion posts at least 3 times per week with substantive research and evidence in APA format. In addition major assignments are required including clinical guideline evidence critiques, systematic reviews and other advanced literature. I have been a RN for 15 years with pure clinical practice in diverse environments. I started with my ADN, had a family and earned my BSN in 2016. I was a CNA at 17 years old, so taking care of people for 20 years will benefit my patients in the future. We are all different, but it takes all types to provide quality care.
Scary that this is what constitutes your education and then you are out taking care of patients.
I started at the bottom as a CNA and worked full time for two years while going to nursing school. I even was a nurse "intern" at a nursing home for a year. My ADN program was 60 credits and 500 clinical hours. I worked as an RN for 7 years full time in cardiac and ICU units while finishing my BSN (another 60 credits and 500 clinical hours) and my MSN (42 credits and another 500 hours). I worked as an NP for 10 years in specialty before I decided to go back for a post-masters certificate (21 credits and 600 hours). So in education years that = 8 years. Clinical hours= 2100. On the job hours before being an NP= 20,000. I will never say I know everything or have more training than a physician. I would like people to know that while residency hours required for MDs are usually paid, while nursing residency/clinical hours are not. I have a roughly independent practice but collaborate with the physicians for advice or to help figure out what I don't know. Both roles are necessary and should be symbiotic rather than antagonistic.
moonshadeau i
Oh boo hoo physician residency is from 3 to 9 years. The former being longer than the whole NP education program
You also have to include 4 years of medical school + 4 years of undergrad degree..
@Zavdex and Hamilton... this person as described 209 credits of course work though a maters and post grad certification. With clinical and practical hours. 20k hours PRE NP completion then another 10years (@3000 hrs each) or practical hours.
Doctors do a PhD/MD class work and integrated clinical hours.
Then residency is the clinical hours in ojt form.
Both professions do the same total amount of education and training but in differing “specializations”.
Your auto mechanic has a different skill set from your auto technician. They do overlaying work but in different ways. Both have a different skill set from the automotive engineer.
Nurses have it harder because they don’t get so much training before entering the workforce. They are at a distinct disadvantage in the power game. An ADN is in no way as prepared for work as a first. Year resident. But they do different work. Thus different entry requirements.
Get that in yur head...different work, different jobs, different education requirements.
@@spartalives yeah bc an additional ~5 yrs of 100x more rigorous training is essentially meaningless. In that case GED's are equivalent to MS degrees, right? I mean they are "different" as you say but it's basically the same amount of work (that is called sarcasm). Everyone loves to redistribute the respect for physicians to midlevel health professions while avoiding physician responsibility .....or until they need one for themselves
Great video Doc!
I've been a nurse for over a decade. Predominantly ER/Trauma. I admit that we used to pull pranks on "new" docs (residents, interns or attendings) - drinking apple juice out of a urinal, eating chocolate out of a bedpan, taping a plastic bag with nails to your chest and shooting a CXR... you know, the usual stuff!!!
But we never (or at least I never) hazed a Doc. I never referred to a Resident or an Intern as a 'Baby Doc' like some of my colleagues sometimes have done in the past. While I have not had a Doc ask me to give up my seat so s/he can use the computer (yet!), I have had Docs sign me off when I was not present so they can use the computer station, causing me to lose ALL my charting up to that point. NOT a fan of that! A GINORMOUS NO-NO with me - if you're the provider and you give me a verbal order for something, and then change your mind after I've administered it - you're dead to me. That being said - that won't stop me from asking you if you REALLY wanted to give Toradol to a pregnant patient. It won't stop me from asking you "the staff is ordering chow from XYZ place - do you want anything?" It won't also stop me from pulling you into the med room to have a 'talk' about your disrespectful attitude and failing a resolution there, an email to your Boss.
We all put our pants on the same way when we get up...
I've had attendings steer their med students and interns to me to show them how to insert a peripheral IV or a Foley (and to this day, I will always THANK my nurse extern preceptor with 30 years of ER experience for showing me tricks no nursing school could ever teach you!) Just last week, I helped a PA administer an IM shot of Penicillin - the whole prep, site selection, equipment needed, the Z-track method, post care... the whole works! She was to observe the whole thing, but I figured she's done stitches, how bad is a shot? Patient had no qualms.
THAT being said - I've also had nurses, techs, radiology/CT/X-ray techs etc. "question" an order. "Why does 'Patient A' NEED 'ABC' procedure?!" Because the Doc/NP/PA says they need it? I'm sorry, but unless you're the one with liability for patient outcome, just complete the order! Disclaimer: this does not apply to legit concerns such as ordering lopressor for a patient with a heart rate of 50, or doing a Chest CTA on a patient with a twisted ankle.
I'm in FNP school right now. I don't really know how it works in the Medical side of things - but I've always believed that "when in doubt, a good Practitioner always consults the team." So far from my 'experience' my 'consult' has usually been other ER Nurses or the ER Docs (and sometimes internal medicine or specialties). I expect to continue that as a future FNP.
Thank you for not being jerk doctors. I am a RN (BSN) and I'm in graduate school to get a masters and become a nurse practitioner. I like that you try to understand everyone's situation before jumping to judgement. Thank you.
Great discussion! You bring up some good ideas! A few comments since there are different levels of education in nursing. I worked with med students at UMC in Tucson AZ taking care of trauma patients, heart transplants, bivads, cardio west patients, ARDS patients, balloon pump patients, vent patients, which taught me mountains! I worked with Jack Copeland who would do a 3rd bypass on CAD patients. My professors who taught me wrote the book!!! So, we NPs had a similar training as the MDs. I did not have a patient die on me for 5 years! Never had to run a code. So, I was hard on my students because I had a reputation to up hold. I worked 20 years at the VA & the first question you ask is how long have you worked for the VA???
We did use SBAR a lot in the Army. They use it in nursing so that we can quickly explain to the doc what is going on instead taking a round about way. However, not many use it in my experience.
We nurses need to raise above the bullying new residents, and new nurses. If we want doctors to respect us as professionals, we need to develop that relationship from the start. Loved the video. Thank you for posting this.
Quote "I was abused when I was Resident, so I'm going to abuse them now as an Attending".
@@SandfordSmythe let’s be honest this petty fight is just about greed. PAs n NPs want more money but don’t want to go to Med school
A 2 year Assoc in nursing it takes 2 years just to get through clinical. And you do rotate all over. It took me going to college year round to just get the prerequisites done before I started clinical. Which involved class time and hands on time in a clinical setting.
I also guilty for teasing new doctors. I also taught them when they needed answers or making mistakes.
I think its mistake to try to paint all NPs with the same brush. Yes, there are (unfortunately) "one year wonders" out there... nurses with barely a year's experience as an RN who start NP school (which I am against). However, they're not the norm. Most nurses who pursues graduate training have extensive prior clinical experience.
I'm currently in NP school, and I'm a Cardiothoracic ICU nurse with 11 of years of CTICU experience (all of it at level one academic centers). I've spent approximately 19,000 hours at the bedside with critically ill patients and their family members. I routinely care for patients on ECMO and who have IABPs/VADs, ect...some of the sickest patients on the East Coast. I'm also dual certified in both Critical Care and CTICU nursing. (Believe it or not, it costs a hospital over $80,000 to train a single ICU nurse from "newbie" to expert...a process that takes around 5 years). And all that is before I ever set foot in grad school.
I'm fully aware that I'll have an immense amount to learn as a new ACNP, and that my training will likely be different from that of someone who's been to medical school. However, my observation has been that the average new ACNP has a "leg up" over the average new doc in terms of "real world" clinical experience, as well in the ability to effectively communicate with and educate patients. NPs and PAs aren't trying to "horn in" on MDs...there is more than enough work for all of us to do. What's necessary if respect for what each team member brings to the table.
How do you have a "leg up" if you do completely different jobs? Nursing is not doctoring
@@zavdex2106 haha try your hand at assessment versus this nurse's experience, as an intern. Good luck and may God have mercy on your soul. Your disrespect is pathetic.
Many NPs and PAs want the respect MD/DOs. Look at how CRNAs are trying to prove they are as good as anesthesiologists. They dont want to be seen as inferior when most of these mid levels are. NPs and PAs want more independent practice. How is that not trying to "horn in" on MDs?
mind blown that MDs aren't typically aware of SBAR!! one of the first things I learned and in certain settings we are required to blatantly document in the SBAR format
Zdogg I am glad you brought up SBAR because I’m an NP and the lead one in the practice I see the majority of the patients and I’m exhausted so there was some re-structuring we now have a receptionist to take calls and we have an MD who was hired to take on some of the increasing load. I recently received a message from the receptionist that my patients nurse called and the message was the patient has a low BP please advise. Well I got upset and was like what else is going on her BP is naturally low and what was the number. I said this to the new MD and she completely understood why I was annoyed and paged on an off day with little info. But when I said SBAR to her she was lost. It’s basically giving me the correct info so I know how to address the problem.
I am a Family Nurse Practitioner. This is a great video. Great discussion.
This was great ZDOG and thank you. Please read this through Dr. Z and would love to hear your thoughts. So there is a lot of data out there that points to the efficacy of NPs as clinicians who practice independently. Some of these studies were published by medical organizations like the AMA, NEJM, IOM (e.g., Primary care outcomes in patients treated by nurse practitioners - A randomized trial). And while many of these studies may have their limitations (e.g., time bias), there is still something to be said with all this data that points to the efficacy of NPs in practice (whether as independent clinicians or in team based environment) and their abilities, even comparable to that of physicians, as you even stated. I think the real debate, and where physicians get "butt hurt" is with the NPs in INDEPENDENT practice. Physicians I find have ZERO problem with NPs in team based environments, but as soon as the topic of independent practice comes up, all hell breaks loose. I think we need to look closer at the data and maybe do a comprehensive study that compare independent NP family practice clinics to MD/DO ran family clinics and see if there is any difference in outcomes or safety. Also in general, these comparison studies need to have more powerful outcomes of measure (i.e., no more using "patient satisfaction" as an outcome of measure). I'm confident that the results of a study comparing NP led practice to MD/DO led practice would be positive and would put some of these fears to rest. With this said however, I think NPs should be barred from entering independent practice until they have substantial number of years practicing as an NP under their belt, and independent practice should be limited to family medicine, and in areas where there is a proven need. I really cant imagine NPs practicing independently in specialties like cardiology or oncology, for example.
Show less
REPLY
I learned SBAR as an intern in a surgery residency program and I think it's brilliant. I wish more MDs adopted this. Clear, quick, potentially life saving.
I think some of the concern is valid. I am in a state where collaboration is still required. In my 10 years as a nurse, my docs have taught me so much. I am in an MSN program right now and I truly believe that my past years will be very valuable.
If I was doing this program straight after nursing school, my level of progress and understanding in the program would be less.
I am next door to another state that allows independent practice after 3 years of collaboration. This seems to be a nice middle of the road solution.
Nurses eat their young because when people feel oppressed they will become an oppressor to who they can. Punching up or punching down is an issue of ego, really a reflection of the "punchers" character.
Jaime Centrella - I think it is more the case that a lot of these old bags went into nursing with idea of landing a doctor - then along comes a young pretty student and they are just consumed with jealous!
@@peachesandcream.2612 I am an old-bag RN who did not go into nursing to bag a doctor! I worked for 32 years in a hospital setting to support 3 children & a sick husband as well as to take care of many clients. How dare you judge older nurses & their backstory.
@@peachesandcream.2612 wow you are completely off mark. And that is very sexist and low. Nurses ear their young is true and part of the reason I didn’t go into nursing as I’m very sensitive. But they do it for a myriad of reasons. Doctors are also very brutal with each other
I have just recently graduated from an online NP program. During my clinical rotations I had the pleasure of working with both MDs and NPs. As ZDogg said we walk in different shoes. NPs listen and pick up on other things than the MD picks up on. We are trained differently. NPs do not want to take the place of MDs but to assist them in providing quality care for all the people in the US.
In Australia we use ISBAR (Identification, Situation, Background, Assessment and Recommendation). It's a very effective handover tool.
ISBARR (from Millitary ) Introduce yourself, Situation, Background, Assessment, Recommendations, Read back
I love this. My wife is an EdD RN with close to 20 years of practice. I get to hear all this constantly. She "strongly dislikes" crap nurses or MDs that question her. I watch your videos because i get to hear all this constantly. She does want to train the little ones. But i use the constant punching down with my kids, but am the one that builds them up and lets them do their thing. Too funny. BZ, keep up the good work.
Love this! You guyz are hilarious. I am a new NP and I feel that schools should admit more experienced nurses to these programs at least a couple of years. We should also work for at least a couple of years before getting Independent practice. I hope I get to be as good as the NPs who precepted me.
To get into NP school you have to be a nurse for at least 1yr prior to admission, so you have several hours of clinical and practice hours. On top of that NP's have more clinical hours before the degree is completed in 3 additional years with an MSN. Minimum 5yrs of schooling and 4 years of practice.
Sorry to disagree but you can get into NP school without ever touching a patient as a RN,
yvette wodan what school allows this? I am curious to look this school up. All of the programs I applied to you had to have been a nurse for a couple of years. My masters program allowed me to enter before I touched a patient but that’s not NP. My first masters was an MSN in leadership and healthcare basically management. I had to put in 500 hrs with an APRN and a huge 50 page thesis for graduation. By the time I entered my NP program I had already been practicing for 7 years and had 500 hrs of clinical rotations to add to the 1200 my program required. Now I’m finishing my DNP which is another 1000 hrs and a dissertation
@@yvettewodan6718 you mean like a PA?
NP for 20 years here (after 15 years as an RN). The stat I keep in my head regarding training: docs spend 80% of training time learning 20% of what they will treat and NPs will spend 80% if time training for 80% of what we will treat. The online programs usually have clinical component matching the brick and mortar school. I like the term mid-level since I work with PAs and this clarifies we are the providers but NOT doctors.
I absolutely love this episode. I am almost done with Nursing school and will go on to get a FNP. One thing I think you don't understand about Nursing school is even at the lowest level that there are super high prerequisite expectations to get in. (3.5 & up) in all Chems, Bio, MicroBio, A&P, math, all of it. Then it's 2 years to get a ADN. Of which clinical rotations are built into the school. So you are taking 16 -20 units and at clinical rotations for 36 hours a week. I chose to get my AA, get a Bachelor's in Kinesiology and then take an accelerated BSN program. I have been in school for 7plus years. I have taken Medical Surgical Nursing, Pharmacology, Pediatrics, OB, Nutrition, the study of Cancer, Medical Ethics, Leadership, and we have lab days and still are at clinical sites and externships and preceptorships 36-48hours during a week on top of lecture. I had a 4.0 in all of my sciences and all classes and throughout my Kinesiology program. I have a 3.9 at the moment in my BSN program. When I am at the clinical site, I learn from everyone, the techs, the PAs, radiology, lab techs, pharmacists, the doctors, the nurses, even environmental services, and especially the patients. There is always someone who is going to have more knowledge about a condition than I have. Patient care and health and wellness is my ultimate goal. But I need everyone in order to help that patient and to provide the resources and environment that is safe and effective to treat the condition. Nurses who get NP degrees have usually taken 7-10 years of college and have had 3-6 years of clinical experience and clinical rotation. I have respect for everyone who has decided to go into the medical field. It's about the patient, not ego.
This is all amazing. It is also not nearly as demanding or thorough as the training to become a physician, in any way. What you name as "super high prerequisite expectations" are the absolute bare minimum for admission to a US Medical School.
Yes, nursing school was difficult. I went through it too. My wife is a medical student - what she is going through is way, way more challenging and complex. It's not even close.
Being a former Telemetry Tech one thing I will say is that I'm appreciate the Nurses that did appreciate me when I did call or for sure the red phone.
IDK what NP credentials are however they do have training. I know in Maine NP does not practice without a physician overseeing them.
Jennifer Berry I’m a nurse in Maine and current FNP student. After completing 2 years working with a physician NPs can work 100% independently here.
Yeah it's all state-dependent. My state has independent practice but I would never do that, lol.
I have worked as an RN for over 40+ years, currently retired. I have worked with NPs and PAs and of course physicians. I have never worked with NPs or PAs who earned their degrees via online. I live in the Seattle area and there is a graduate degree program for nurse practitioners at U of W. The program was intense with areas of specialty in OB/GYN, internal medicine, general surgery, ER, and family medicine. I had three co workers who went through the program. In my opinion, the better NPs were ones who practiced as an RN for at least 3 years in an acute care setting. I also believe that for nursing practice there should be a standard. Currently, to be an RN one could have an ADN or a BSN or a graduate from a diploma program school of nursing, though that is rare.
glad to see the honesty. I know an older PA and she is super knowledgeable. I know a newer NP and she I (I'm an RN), really try to avoid referring to her if I can. Her cookie cutter approach scares me, for the patients. But then then MDs, I feel really confident referring to them, but sometimes there is arrogance and they don't take time to listen to me or the patient. But thats certain individuals, some do listen better.
Don’t worry. Nurse practitioners also get confused by all the different degrees and certificates etc. I suspect many of us, that have been around a while as nurse practitioners, worry about a lot of the same things physicians worry about with some of these programs.
One thing you’re missing about a two year degree just like a four year degree you have to take all your math science is chemistry A&P, micro biology ,psychology, ethics management, planning. So really it takes you 4 years to get a ADN and 6 years for a BSN
ADN is 2 years of requirements and 2 years of nursing program. I am not sure about the online classes.
NP, PA, and MD/DO we all have a place and can work together. Let NP's and PA's see the more stable patients so the MD/DO's to see the more critical or complex patients. We can be a better healthcare team if we work together. We need to stop saying MD/DO's are better than NP's/PA's or vice versa, we all do different things and bring different qualities to the team, and our patient will do better when we can all work together.
Thank you!!! As an Advance practice psychiatric nurse I do not do the same thing as a psychiatrist and I get frustrated with the comparisons, whether positive or negative. I am more focused on helping the patient take on more of their own care through education and communication with the other team members and I will consult with psychiatrist, psychologist, pharmacist, physical therapist, nurses, social workers…to help pts get what they need so that if they need to be seen by a psychiatrist the problem is very clearly defined and we have ruled out the lower level stuff.
Youre delusional dude. Yes NPs/PAs/MD/DOs do different things but that doesnt mean there is no hierarchy. NPs and PAs are midlevels and they shouldnt be telling patients to call them doctors and wanting to be viewed as physicians.
@@mike112693 "Midlevel" meaning what? You couldn't define that word coherently if you tried.
And hierarchy? I'm sorry, I've been an independent NP for 10 years with near-zero involvement of physicians in ANY aspect of my practice unless *I* opt to consult with them, like any provider (MD, NP, or PA) does when appropriate- what hierarchy exactly do I fall in?
@@isocarboxazid I think it's pretty straightforward. Mid levels are lower than physicians on the hierarchy because they don't have the training comparable to physicians. Generally, a fresh np graduate would not be as prepared as a physician who just graduated from residency. Midlevels are above nurses, techs, etc. because the latter can't handle the patients the way the former can.
What’s missing here is there are multiple hierarchies happening in a medical setting at one time. Which means it’s not just one up and down power structure.
I am an NP who currently works in Orthopaedics. I've had MDs look up to me as a specialist even when my surgeon is not around (he checks in weekly). I will agree. There should not be such a thing as a complete online program. Everyone should be present in class. Everyone deserves to practice under supervision for a few years in whatever field. I think it would be safer for us all. I also teach NPs in orthopedics. I love what I do. But I wish we took care of our own a little more.
You can't do a completely online program because there's the clinical component that is completed with an NP, DO or MD. That is on top of the classroom work. I've been an RN for over 20 years. 12 of that was in adult ICU, 4 in a Level II trauma center and 9 of those 12 yrs as a CCRN.
NIce!!!! Would love a week of training. Sure wish we could collaborate like this. How awesome would that be????
hey how long did you work as an RN and what route did you take to become a np in orthopedics?
@@kaknurse Basically no online bullshit at all. This isn't undergrad, people can die.
Stephen Johnson - Why don't you just try to get into medical school - I am sure that they would love to have you with all that training and experience! God Bless 💕
Georgia has phased out MSN NP programs now - they are grandfathered in, but now entry level for a nurse practitioner is a Doctor of Nursing Practice (DNP) degree.
Such a cute couple!. :) I'm currently enrolled in nurse practitioner school, and I for sure would not for one second think I'm a physician once I graduate. I totally agree that the problem solely arose from the fact that we " don't walk in each other's shoes." It will do the healthcare system a great deal of good when each counterpart respects each other, and practice according to their training. I will not confuse a doctoral degree in nursing for a medicine degree; however, nurse practitioners are here to render support to physicians; especially considering the shortage of practicing physicians in most rural areas.
Love this whole video but the last four minutes are the best!
Love hearing z talk about SBAR 😂 never realized docs didn’t know sbar?! Thought that’s why we used that form to report. Kinda eye opening though 😱
Nurse Practitioners students do not spend all their time online. We have required handon clinical rotations that we must be complete, as well as pass national certification exam . My program is rigourous as many are.. No i dont have a medical degree but I have 20 years of ICU experience and I feel this experience will be very valuable to me in the futue. The key is to know your scope of practice and limitation and when to seek out expert care. We are the same team this is not a ego thing we have to put patients first and do what"s beat for the patient.
I am currently in nursing school and will be going on to a doctorate degree in nursing as a CNM/NP. NP's are trained to know their scope of practice and work within it. We are taught our boundaries and how and when to hand a case over to a doctor who has a larger knowledge and skills set. I feel that NP's serve a valuable role in the healthcare setting. Jealousy and bullying between professionals in healthcare only hurts our patients and serves to breakdown healthcare delivery. That said there are some who do not work within their scope of practice and over extend themselves and their knowledge.
Not all nurses eat their young. I promised myself that I'd NEVER be that nurse. Teaching new nurses and students reignite my passion for nursing. And associate degree Nursing school is 2 years. But you have 2 years pre-requisites before you GET to the nursing program. I was in class and clinicals at the same time. I came out of school with great skills. I'd put myself up against any BSN nurse any day of the week. Kudos to those who went through a BSN program. But I was learning units and then practicing while it was fresh. And I came out of school out of debt.
As for -
S- Situation
B- Background
A-Assessment
R-Recommendation
When practitioners- MD/NP/CNM/PAs embrace this, they end up loving it. It's concise. And comes with better outcomes.
We also use CUS words
C- I'm Concerned for this patient
U- I'm Uncomfortable with this Med/plan of care, etc
S- I'm worried about the Safety of this patient.
NPs in my experience are more likely to do teaching and take a nursing approach. They are better at grass roots prevention. They come from that nurse soul.
The difference I see is that NP new grads LISTEN to the nurses and the patients. New doctors do NOT. They have something to prove. And that is key to patient safety and success. As a nurse, I'm always willing to help. But new NPs will ask for help.
Example: NP-
SBAR given
"What is usually done in this situation?"
Nurse explains XYZ
NP: "Well let's do that. And call me if it doesn't work."
The Same situation with a new grad doctor.
SBAR given
New doc: "Do XYZ"
Nurse: "but if you do X and Y, Z is not possible. It won't happen."
New doc: "nope. Just do it. *click*"
Fast forward to 12 hours later and the doctors pt has moved to the ICU.
*disclaimer- there are exceptions to this example, but this is my experience.
An MD who has been a doc for 25 years recently told me, "I'm always learning from nurses. They always have the best ideas." My response was, "yeah! But you're willing to listen and TEACH us too. It's a two way learning street."
PS- I work with a Pediatric NP who is a Doctor of Nurse Practitioner, that is smarter than 95% of her MD peers. She even writes all of the newborn policy for our hospital. And she's a lactation consultant.
Happy Father's Day!
Nice examples, but dont use them to convince yourself that your patients should view you as a physician. NPs/PAs are generally inferior to a physicians training. If you want to not be seen as a midlevel, go to med school.
Also, congrats to Logan on his success in human cloning! 😃
Very surprised about the SBAR response! I had no idea that it's not even mentioned in MD training/education. Maybe it should be added in as a way to correct MD-RN relations/communications especially with new MDs in july.
I earned a Doctor of Nursing degree from the very esteemed Case Western Reserve University over 20 years ago, therefore, sir, I'm absolutely entitled to refer to and introduce myself as doctor .... just the way you and all clinical and research professionals with earned a doctoral degree do! One of the problems here is that people often confuse title with professional role. Your role is as a physician, thus you can use the title "doctor" because you hold a DO or MD degree. My role is of a nurse practitioner, and like you I have exactly same privilege and right to refer to mysel as "doctor." We NPs are trained from day 1 to fully understand both the need and nature of the collaborative relationship between nurse practitioners and physicians. As a UCSF graduate student I had an entire course specifically on this issue. We are taught how to work with physicans caring for patients in the healthcare industry. Are medical students taught how to work with NPs? That alone might really help becasue this is the way things are, and NPs and DNPs are not going anywhere. As fewer physicians fail to fill the primary care needs of Americans, NPs and DNPs are and will fill that void. It's just the way it is. If you really want to learn more about us so you can speak about us in an educated and sincere way, ask to speak with a Dean of a DNP or PhD nursing program at a top school like CWRU, UCSF, Emory, Tulane or Penn. I think you'll learn a thing or two and surprise yourself. BTW, I became a nursing doctor instead of a medical doctor for many reasons, some person, but mostly they were philosophical. I consciously chose not to become a physician, so it's a bit shortsighted of you to think that we, as NPs, may think of ourselves as physicians-as if being a physician is the be-all-end-all in life! You, and others who think like you need a dose of humility becasue this smugness, it's really gross!!!
I agree. It's unfortunate physians adopted the title "doctor" so many years ago. The title "doctor" actually belongs to any one earning a doctorate degree.
To patients, physician and doctor are basically the same thing. Please don't expect patients to call you doctor in a medical setting when they actually want to see an MD and not a nurse. You NPs want to be on the same level as MD/DOs but you guys are still midlevels. Your training is still inferior to MD/DOs and 90% of people would rather see a physician vs a nurse.
THANK YOU!!! Bravo!! I agree with every word written here!
Dr. Lana Brumfield, Ph.D., MS-N, AGACNP-BC
Professor of Nursing
@@mike112693 ... wow are you ever misinformed. You need a solid education there Mike. You are way off! Midlevel? Never heard of it. Cite your sources.
@@anthonydavid5121 can’t tell if this is sarcasm
Maybe some doctors aren't in medicine for the patient but for the power. Think about it, why does the thought of a NURSE being able to diagnose makes them so angry? Many will say academics, intelligence, whatever, but you cannot discount 15 years of ICU experience in a high acuity setting. Yes, online programs aren't the best but many NPs do sit in a classroom just like medical students. If you look at the research you will see that NPs on a team are extremely beneficial in many aspects (patient outcomes, readmission rates, infection rates, rate of follow-up, education, etc). Therefore, why don't we look at facts rather than the opinions of physicians who have never worked with NPs.
Situation: who is the patient, what in general is going on that relates to why I’m calling the Dr.
Backround: information that related directly to what may be wrong. So vitals or a new finding. Assessment: what did I as a nurse assess that made me want to call to seek a medication or whatnot.
Recommendation: sometimes it’s obvious what needs to happen like a new pain medication or maybe the physician needs to come assess a dressing.
Repeat: repeat back to the physician what they told me so nothing is missed.
I’m a NP in the ED.
Wow, I am surprised that physicians do not learn SBAR - I thought that it was something that we were using as a team = All these years, the doctors, had no idea!
I've done brick and mortar and am now doing online at Washington State University. It is actually a lot HARDER to do online because you have to be self-disciplined, and often times when you don't know something, you don't have time to email the professor and get an answer in 24 hours. Often times you have to look things up yourself and it's a lot of self-learning.
Don't get sick in July, or the weekend. Or in the USA.
As someone who is in an acute care nurse practitioner program, I completely agree that nurses and doctors just are not the same. Each bring their own 'style'. I do however believe most NP programs are a joke. My program is majority online, but the acceptance rate is relatively low but graduate rate is acceptable. I had 2 years of experience as a rapid response nurse, multiple certifications in critical care, and numerous hours of experience, but I still felt that maybe I was going into this program too early. When I think like that and then I see these people getting 6 months of nursing experience, (At this point, you probably don't even know what medicine service does what, because I was still pretty lost at 6 months) getting into NP programs and then going out to be a provider. Even to me, that just does not seem right in most cases. Granted, I do know there are always outliers in these situations.
Now, I do not know the entire curriculum of med school but I believe there is too much fluff in NP programs compared to med school. I personally want more clinical hours, I want more time with a patient, and I want more time with people that know more than me so that I can learn and be a functioning provider. As far as being called a mid-level, I personally do not care, it's just a name. Now if that name is associated with 'mid-level' care as some have mentioned then, yes, I would have a problem with it.
Great video though!
I agree, (This is going to be a long comment) I'm from Australia where nurse practitioners are so very far behind those of the US quite apart from having slightly different approach to health as well. Nurses and doctors may have many aspects of their jobs that overlap for the good of their patients but essentially they have different approaches to their different jobs with different outcomes. So in Australia a nurse practitioner is rare. We are developing this role to service rural and remote communities, fast-track patients through emergency departments, some are in primary care and nurse practitioners are only just beginning to pilot projects in geriatric medicine and management in nursing homes, acting in the capacity of a locum GP, ready to detect and treat client deterioration before it warrants a trip to ED. I am a nurse, I think that the line between doctors and nurses is going to blue further and further for the benefit of patients. There may be a hierarchy in health care, but no one is going to do your job for you. In Australia, sometimes a doctor doesn't Ok an order for hours after a patients needs the intervention. For these times there are standing orders and nurse initiated treatments as well as clinical protocols. I was once in an education session designed for interns as a student nurse. My palliative patient was asleep and I had nothing to do for a while so I went. We went through clinical case studies and deferentially diagnosed and managed the clients. The interns quickly reeled off different initial interventions and differential diagnoses but nothing in terms of continued management. One client was a baby with a suspected case of meningococal disease. The interns listed off a nuro assessment, sputum, urine and blood tests to confirm the illness, pain relief and managing the temperature, but no one said that the baby should be cared for under isolation care to prevent the spread of this infection to other children and other patients and health care workers, the family, brothers sisters, mum and dad should be brought in for a check up and a vaccination, no one said the baby should be re-hydrated intravenously because he wouldn't be able to keep fluids down, that his fever should be managed to prevent febrile convulsions and brain and tissue damage. but not only did I anticipate what the interns were going to order for this child and say prepare for blood/urine tests, the glass test, a baseline and five minutely sets of obs, but I also suggested an order for hourly 80 ml boluses of saline and electrolytes, pediatric doses of antipyretics and manual cooling of the child through sponging, isolation and PPE for nurses caring for this baby, education for the family to prevent the spread of infection to the family as well as if illness is confirmed timely treatment and hospitalization so that his needs can be met and the illness doesn't spread. Not one intern had said any of those things. That scared me. And I think it scared some of the interns when I listed these things after the things the interns had said. This taught me that though we have different jobs and responsibilities, we must overlap in a lot of areas, and this must be for the common goal of helping the baby recover, and the family of the infant. Australia's Doctor Nurse relationship is collaborative as it is and the introduction of NPs to this system has been slow and difficult because of this existing relationship, many doctors are unwilling to work with them because of this long standing assumption that nurses and doctors don't overlap, because they do absolutely they do. Many doctors are resistant and reluctant. for many of the same reasons as in the US. In this experience not only was I surprised that the doctors wern't thinking of continued management of the patient but i was surprised that many of the more experienced nurses wern't thinking of initial differential and anticipating doctors orders, or thinking of what could be done by the healthcare team to get to the bottom of his problem! I think that the far future of nursing round the world will see nurses take a leading role in co-coordinating and managing care and more of a role in differential diagnosis and initiating initial treatment of client problems, the nurse role will become more and more collaborative with the two doing many of the same jobs for the same outcome but using different approaches. I would like to see this line between doctors and nurses and this hierarchy blur too. In healthcare no one is better than anyone, no one has a more important job than anyone. we all have the same goal, each with a different approach, so there absolutely must be some overlap between doctors and nurses in terms of the things that they can do. In Australia it doesn't much matter that the doctor orders the drugs when a patient deteriorates or the nurse gives them as a standing order or a protocol as long as they are given appropriately. I once preformed a patients ECG for admission to rehab, in it there was a PVC and throughout an irregular rythm. I knew she was odematous in the lower limbs and was already on digoxin and lasix, I saw a need for a review and so I brought the ECG to the attention of her doctor with a recommendation for a blood test and a meds review. I thought that the doctor wouldn't listen to me because I was only a nurse but he did, and I found that I helped make something very important happen for a patient who was at increasing risk for cardiac deterioration by collaborating with her doctor. I don't think the hierarchy or the line between doctors and nurses duties matters as much as the recovery and care of the patient.
Nicholas Thrash You think you were under experienced? Think of someone in a PA program with literally 0 healthcare experience going to school 2 years and becoming a provider
I think this problem may go away with time. The NP profession is so young that we haven't really had the chance to legislate as fully as is necessary. There quite simply isn't enough data yet to legislate against certain types of programs.
Yeah I’d agree wt the whole online thing. I went to med school for a very short time but long enough to get a grasp of the culture. Lol in general you really didn’t have to be in class. A lot found it more efficient to learn at their own pace by watching lecture videos. It’s just a lot of materials and, since everyone learned differently, you really had to find the best way of learning that’s most efficient for you. We also hardly read the text books which was a complete waste of money. The only class I would say is important to be physically present for is lab.
What a wonderful family moment!
One of my nurse practitioners was called in for hand holding during a life threatening illness I had little chance of surviving but he discovered my horse was already doing that job very successfully. However whenever I have anything seriously wrong with my health I have hyperventilating panic attacks, especially in the morning so he medicated me for that.
I am a PA. When I went to PA school at UCD, the NP’s were in the exact same class. I have worked with quite a few NP’s. They are capable and intelligent. The NP’s with 10 letters after their name I would avoid. They seem to be policy driven. Nurses, the same. The best RN’s were educated in Junior College, the associates degree. They actually can get in and help. It is one of the main reasons why I worked at night in the ER. The same nurses most of the time and NO administration !!
Im pretty late on this post, but I am going the route of NP which is better suited for flexibility as a mom to a toddler. Medical school will always be my first love but i want to be home more than i am at the hospiral. With that being said. I cant believe this is even a discussion. Intelligently, the training for NP's and MD's differ from varying to great degrees. Why is this even an argument? Physicians study the scientific functions of the human body in great depth far into the disease process with focus on diagnosis and treatment; from a canker soar to cancer. NP's are trained primarily in preventive measures with more intuitive strengths for the care and management of the well-being of a patient; from mental health to patient education and primary care that does not require a specialist. I can't believe feel the need to clarify, but yes nurses and NP's have some education on the sciences as well, but mostly introductory, not a primary focus like MD's.
These (yes i said these. Because we all know which nurses "these" ones are, these "digruntled" nurses that feel they "know" the patient "better" because "they've spent more time with the patient." Are viewing the lens from an intuitive and a "bedside" point of view, when the MD's hat is on quickly using all his/her training in the sciences and disease process for assessing, diagnosing and strategically setting out a plan of care. Nurses are responsible for carrying that care out and do not have any training whatsoever to properly and effectively diagnose a patient without possibly harming them in the process. However, NP'S may be able to diagnose, treat and prescribe medications, working in tandem with physicians; should there be something outside of the NP's scope of Practice is where the MD steps in to fill that role. As a Medical Assistant working in a level 1Trauma Center in a large city, I have seen this "hate" and spite more so between nurses and physicians than with NP's. I will tell you that there is just too much "ego" going around when patients lives are in one's hands. I dont find doctors deplorable. I respect them. How is that possible for a medical assistant and not a nurse? The truth really isnt a fight for NP's to gain equal recognition as an MD. The real issue here, (if there truly is one) is that there is complete misinformation here about the roles of each one. The education and internship an MD is required to complete is required for a very important reason. Sure, if MD's could just be clearing soar throats and ghonnerrhea...but unfortunately, the human biological and physical makeup is much more complex than that. So anyone who is looking for some 'loophole' for the type of recognition an MD has, should have went to medical school. Btw, i have equal respect for every hand playing a role in patient care. I dont give respect to a doctor more than I would an administrative staff or "mid-level" whatever. We all have roles. We play them. Stop complaining and just do your job. Be there for patients and hang up your "ego" at the door. That is my two cents. Can't wait to become an NP!! Maybe when my son is off to college will i try my hand as an MD. Great post. Doctors are unbelievably awsome. NP's are caring and nurses, can't do without you.
Good post. Need more NPs like you that arent so arrogant.
Good video! But all NP schools are not online. There are a lot of in person schools. ( UCSF, USC etc)
I think it's fair to both acknowledge the butt hurt was ridiculous and acknowledge that at times nursing lobbies make statements, "studies," and political moves to really factually equate themselves to physicians. That's wrong. Not that by virtue of being a nurse that they are less, But by virtue of them literally having less medical knowledge. Is that the only thing that matters? No. But it does mean that those physicians were triggered by LEGITIMATE issues.
I don’t know a single nursing organization that is attempting to equate themselves to physicians, or a single study sanctioned by said organizations doing the same. Not to say there aren’t individuals attempting to proclaim these sentiments, but it’s definitely not the goal of any legitimate body of nurses or nurse practitioners.
@@codywalker3747 look up "Cathlopathic physicians." Also reference NP vs Physician 6 month outcomes in Diabetes. That's an organization and studies being used to attempt to equate themselved to physicians. From this moment on, any ignorance on your end is willful.
I am a Family Nurse Practioner. I worked as an RN in CV-ICU and ER for 12 YEARS prior to going back for my MSN. I continued to work while attending grad school, while raising my children!! I’ve now been a “NURSE” for 20 years!!
With my background clear, let me say, NURSE PRACTITIONER students, (even taking online courses) HAVE 90+ HOURS of clinical/ hands on each semester with an MD or NP. Your last year is basically an internship of 180+ hours each semester while writing your thesis!
There are GREAT NPs and HORRIBLE NPs, SAME WITH PAs, MDs, ETC!!
If you are concerned about seeing a NP, find out their BACKGROUND as a nurse! Without my nursing experience (MANY codes included), I would not be the NP I am today!
Even after all these years, I admit I do NOT know it all!! I’m constantly learning from everyone around me! I respect all my coworkers no matter who they are, because everyone has something to teach and learn!!
When first I was a nurse, I made sure I engaged expert nurses, nurse practitioners and willing docs who would continue my education while I practiced and continued my academic education. I had folks in every level of providers to call when I had questions. I was gifted by these people and really did become expert in my field.
SBAR comes from the military. Was adopted by airlines and eventually some areas of healthcare. The challenge of sbar is when others are not familiar with the concept in which the idea behind sbar falls apart.
I applaud you for addressing this . I have been practicing for 28 years all in critical care as a nurse and 18 of those years as a a clinical nurse specialist . I have been very blessed to have worked in mostly collaborative healthy work environments .. at the end of the day .. we all bring something unique to the care of a patient and ultimately patients will always be better off when we let go of our historic basis and embrace what we can collaboratively bring to the patient .. There will always be someone that knows more about some unique aspect of patient care than I do.. the key is acknowledging that and drawing on those individual to bring he best we can in the most efficient manner . Ultimately it is up to the leaders formal and informal to set the tone for this .. what is tolerated is accepted. it is as simple as this if the attending washes his hand on teaching rounds before entering a room all the residents rounding will do the same - if the attending does not ... the residents will not
A little late to posting on this, but there seems to be a case for nurses being trained by doctors, not other nurses. (BTW, I am an RN and starting medical school next month)
RNs with an ADN from a community college needs to complete 60 units of college credit before they can apply for the ADN program. Doctor stop assuming. Both ADN and BSN are really four years of education not just two years
Thank you! Perhaps he should interview a nurse (RN) as well as a board certified NP. 2 doctors assuming what it is that we do... recipe for disaster and misinformation.
I insisted that everyone call me Mrs T… when I first entered. Had to call docs Dr. Then they would call nurses by first name. Just by doing that docs let nurses how the hierarchy works. I insisted on a collaboration and actually got that outcome. Once the docs told me to address them by their first name I allowed them to use my first name. One of our docs came to me and said “you have been here for two years and I still don’t know your name.” To which I replied, “My name is Mrs.” He was such an arrogant doc. Could not read his orders. Refused to use the stamp with his name. When orders were misread he insisted that nurses were at fault. He never even tried to write so that others could read. Smart man but too arrogant to work with the team to keep patients safe.
"Why can't we all just be friends ?" That's what I'm gonna keep saying to people everyday during July.
I'll be known as the crazy guy, BUT, if everyone has hate for my annoyance, hate will unite everyone against me, which is AWESOME, cuz everyone can get along. Pretty smart I know.
Question why nurse practitioners are let loose to act in place of a MD ? I have family member that died of cancer since NP did not order tne correct testing he went to them ever 6 months why the law aloud that ? Is very dangerous instead government should provide free med school to relieve the shortage
I love y'all really are a family not just work buddies.
Thanks for creating this dialogue.... Nurse Practitioners are not MDs; the education is not the same as medical doctors... NPs have their own advanced practice education models that address the needs of the medical community (primary care, acute care, OB, pediatrics.... etc...). The training certainly does include extensive didactic as well as clinical work, mostly under the supervision of attending MDs...
Since the medical community is so heavy on evidence based literature, let's explore the EB data on patient outcomes; residents/MDs/PAs vs NPs... This would address the questionable care given by NPs...
Let's stop the speculation, end the division, look at the data and put this issue to rest...
there is a huge learning curve for Rns also. We learn the basics, but once we enter the floor, it is training on the job, I worked for 18 yrs and I swear I learned every day something new, and before that I worked 10 yrs and that was a huge learning curve after graduation. And how about sexual harassment that nurses have to deal with??????? I was harassed by a pediatrician and a plastic surgeon, It was humiliating and no one did anything to help me. My husband a pediatrician was harassed because he was Puerto Rican, even though he graduated from Cornell Medical school, even was assaulted by another doctor. It was plain jealousy.
I've been a lurker for all of AMA and Incident report, but I just need to say right now that I love MrsDoggMD. I'm with you, MrsDogg--I don't like the term "butthurt" at all, but I've never told Z because he'd just react by saying it 40 times. ;)
You did a great job of breaking down the topic and ferreting out some ego roots that it traces back to. As a CRNA student in a doctorate program, I see this behavior rear it's insecure head on my channel occasionally. It's usually on a video where I'm discussing the rigorous coursework or capabilities of a CRNA when a med student or resident pops up with uninformed, insecure negativity.
I love this conversation. Unfortunately, everyone is ALWAYS going to be butthurt about something haha
You included your undergrad work (3 years) but didn't include the undergrad work for ADN RNs. We have to do our general education and prerequisites to the nursing program, take an entrance exam (albeit much easier than the MCAT), which can take 2 years or more. Also, to be an NP is another 4 or 5 years. So you say you have 3 years of college, 4 years med school, 3 years residency. Nurses have 2 years college, 2 years to become an ADN RN, and 4-5 more years to become a Nurse Practitioner (to finish getting their BSN and MSN if they don't do an accelerated program). That doesn't include the time they take to get their terminal DNP if they choose to. Comparing your education as an MD to the education of an entry level nurse doesn't translate or accurately reflect the education of an Advanced Practice Registered Nurse.
It was an old school MD that suggested I become an NP when I told him I was considering medical school.
Had no idea that you guys didn't know what an SBAR is. We were trained to do this for you guys so A) we don't skip info that may be pertinent to the case B) put it into a systematic form that makes it easier to grasp when you know zilch about said patient
Coming from a nurse who has never worked with a resident (and not to justify in any way nurses bullying residents), I wonder if it's a challenge to navigate that relationship when the resident is putting in orders but nurses can't rely on residents' judgment and knowledge as they would with an experienced physician in following those orders. Of course we don't follow any order blindly but there is a bit more anxiety when dealing with decisions made by residents, no? Kind of like taking care of a parent who is behaving like a child (mental illness, dementia, etc) but you still need to treat them with respect and preserve their autonomy in a way you wouldn't have to worry about with a child.
I don't think people understand how much clinical time we actually work as a staff nurse before we go into the Nurse Practitioner.
Some of you, many of the new ones do not.
NurseSarah NurseSue - It's just a load of old rubbish! Who would be stupid enough to see someone who is like a doctor - but not a doctor - and not as good as a doctor! Apply to medical school if you want to be a doctor!
@@peachesandcream.2612 We don't want to be doctors. Many of us could have been doctors. I actually was Pre-Med and changed my path due to wanting to go more the nursing route. I like building relationships with my patients the nursing model was best for me.
Stephanie Little - Actually, that is a very good point! I can well see how patient/practioner relations would be better than with doctors - you know - the old white coat syndrome - and having to call them "doctor" all the time! Plus, I really like African American people - and I like to see them taking up their rightful places which they were denied for so long due to cruel and ignorant racism! I do wish you every success and all the very best! God Bless you 💕
Actually nurses will get an associate degree first and then most will get the BSN. Not all nurse practitioners go online, a lot of us actually go to brick and mortar. As far as bullying, I remember it very well...it is a sad thing that occurs in the nursing profession. As far as myself I actually practiced as a masters prepared nurse for over 10 years before I went and received my post masters FNP. I have been in a class with those that do not have a lot of nursing experience and I think that this is a hinderance as you don't often get to have a lot of experience as some of us do...to develop that gut instinct. Personally I think online schooling is not the best way to go for your NP schooling. I think hands on is best. Plus it is a lot easier to secure clinical rotations when you inform the facility/preceptor that you attend a local university.
Nurses don't want to lose their jobs because of an inexperienced Doctor. My wife, an emerg nurse stays with me when I go into the hospital. Why? They sometimes fucjk up. And she catches it. I've been in the hospital three times, each time there were reportable offences against the doctors, nurses and management. How sad is it when I would rather die from appendicitis with two sections of eschemic bowel and a hernia with 15 lbs of infection. Rather than go to the hospital .
Healthcare culture is changing. The doctors are providers who started practice in the 60's, 70's and even the 80's are retiring and leaving the healthcare environment. This is important and has a big impact on healthcare. The attitudes that were ingrained into these providers persona do not fit todays standards.
During those times, RN's were only women and a male nurse was a true oddity. Our society place and attitudes towards women during those days were a lot different. Rn's were required to wear a skirt and the traditional RN cap. RN's were required to give up their chair for a doctor and the culture of a doctor being "better" than a nurse was the norm and the accepted standard. Doctors never asked a nurse their opinion. The doctor was lord and king of his domain, the wards and units of the hospital. Also, the MD culture at the time was of eating their young in order to make them tough and wise, because if you were weak, you got culled from the group (look back to the culture of interns/residents in those days). It was not only accepted but expected. The call schedules were deliberately brutal for these reasons. Also, doctors treated the staff, nurses and interns/residents because thats what they saw growing up and also a little bit "I am treating you (the resident/intern) this way because I was treated this way and now I can give people crap instead of taking it.
Some of the attitudes, beliefs and actions of providers today are still influenced from those times. But as these people retire, these attitudes and actions are fading away. This is the golden opportunity medicine and healthcare needs in order to jump into the future and into Health 3.0.
All providers have an important and distinct role. ARNP's, PA's, MD's, DO's, etc need to work together utilizing our various strengths and attributes in a symbiotic manner, in a collaborative environment, to provide the optimal care to everyone. We need to form our own identity and culture as healthcare partners and leave the past in the past.
So much about voice quality and personality. If someone is not strong in either, ends up doing. The grunt work and running around
It probably wasn’t just about the relationship between nurses and doctors. For nurses to be working in an environment that causes them to strike the chronic short staffing, lack of supplies, lack of managerial support, denial of vacation or sick days and overuse of mandatory over time will make anyone mean. And mostly in my experience nurses save as much nice as they can for the patients.
New nurses that behave like the jerk interns are real too! My program told us," we teach you to pass the NCLEX and learn the basics". "THEN THERE IS THE REAL WORLD!"
My doctor had me schedule my c-section June 26th 2 weeks before my due date to avoid the interns😝
I am a R.N in a teaching hospital, I'm not a fan of July, but I am very patient. what pisses me off is when the Interns forget to order labs, then have the nerve to put in orders "States Floor To Collect, this means I am expected to stop what I'm doing to draw these labs that are not Stat, because the interns forgot to order them, first I'll page them "why is this stat, is something going on I don't know about, if not then I undo their order and put the order in for the next phlebotomy round. then kindly explain that stat labs cost the patients more money, and if I bail you out, how will you ever learn, 😆
What if you interviewed an actual board certified NP who is also a Professor of Nursing who teaches undergraduate nursing courses for BSN students as well as graduate level NP students? The real answers to your questions regarding the profession and practice of the Associate Degree Nurse, the Bachelor of Science Nurse, and the Advanced Practice Registered Nurse (Nurse Practitioner). would be actualized. The bottom line is that excellent patient care is at the center of what we all should collaborate to provide. Stop comparing years of education. A Ph.D., 2 Master’s of Nursing, and a BSN calculates to a minimum of 17 years of college and clinical practice; as well as research, dissertation, and defense. Let each individual choose their pathways, seeking only excellence.
Respectfully,
Dr. Lana Brumfield, Ph.D., MS-N, BSN, APRN, AGACNP-BC
No matter where you go there will be bullies. Gotta learn to deal with them early on or you're limiting yourself.
I know this is an old post. I’m nice to the new interns because they will hate nurses for the rest of their career if you treat them like dirt and it makes for poor care and if they are arrogant and treat me bad I just ignore them. I have made many friends with interns over the years some are amazing and it was an honor to know them and others just suck, because they don’t listen to any concerns and just became a doctor for status. You can pick those out right away. They are the ones that let you know day one your just a nurse and any education you have offer the patient should be take with the grain of salt at best. If your nice or even a scared intern, I will go out of my way to make you look like a million bucks to the patient if you treat me well. If you think I’m just a lowly bedside dog that fetches things then you’ll be in the supply room by yourself. Mutual respect his s long ways.
Sure the travel nurses are happy and nice because they won’t be there long and are offered like $70hr plus so with that kind of pay and not knowing who are jerks at the hospital makes it easier to work. I don’t travel but have friends who does and they say the same thing that they are there 12-13 weeks so they don’t take things personal to where a staff nurse been there for years and like you said who knows what could have eroded the relationship
I think your wife is wonderful! Refreshing to see a doctor who is thoughtful.
Is that Han Solo Frozen in Carbonite?! 👍