I was at a memorial service today for a former colleague. People were telling stories and making comments about the person and this was one of the comments...
I never thought of him as a nurse, I always thought of him as a colleague.
I hope it's evident to you why this is an absolutely dreadful thing to say.
Showing posts with label nursing. Show all posts
Showing posts with label nursing. Show all posts
Friday, October 30, 2009
Tuesday, March 3, 2009
Us Vs. Them
For the complete background on the NP role (as seen through the MD lens) read the following:
http://www.acponline.org/advocacy/where_we_stand/policy/np_pc.pdf
This is a position paper by the American College of Physicians on the Use of Nurse Practitioners. Embedded within are all of the insecurities that ACP has about NPs 'encroaching' on physicians work. They repeatedly state that MDs have more extensive training (I don't think anyone in the NP world argues this point, but the MD side constantly states this) and that NPs should not be seen as a way to replace physicians.
I see this as a lot of double talk. The article acknowledges that very few med students go into primary care which is how the NP role sprang to life, along with PA's in the 1960's. It goes on to say that NPs provide an invaluable service in rural areas and areas where medical needs exceed demand. Then it also says that the NPs shouldn't be replacing physicians and that they should merely be an adjunct to the MD. They also seem to say about a dozen times, that NPs should not practice beyond their scope, but then they also go on to say that NPs can meet 60-90% of needs in primary care so it would seem that they are acknowledging that primary care is within the scope of the NP's practice, right after they fretted about NPs practicing beyond their scope.
They state how patients that have NPs may have better outcomes than when they see the MD, but then go on to poke holes in the study that found this to be true. They state that NPs are nursing and MDs are medicine and that they are practicing two different arts and that certification exams should be drawn from each background, but yet state that they are not opposed to a NP centered health care team in addition to the physician centered one but that the NP team must be held to the same standards as the MD centered team although they are quick to say in other parts of the paper that NPs and MDs are different animals. If they are truly so different, why should the same standards be used to measure the success of the NP led team?
As early as 2012, the DNP certifying exam could be a close relative of the US Medical Licensing Exam, which could show the MDs that NPs can also pass the exam. Needless to say the AMA and ACP both do not want NPs sitting for the MD medicail licensing exam since some MDs have long held the belief that once NPs take the same certifying exams that MDs take, they will be treated as true colleagues. With this possibility approaching, the AMA and the ACP have put out position statements saying that nurses should not be taking a medical licensing exam, they should be taking a nursing licensing exam. One could theorize that the AMA and ACP are afraid of the success rate of NPs taking a medical licensing exam so they oppose the use of 'their' test.
All of these leads me to believe they are running scared and noticing that Medicaid is recognizing the NP as a primary care provider (there is a new bill now which would require Medicaid to reimburse NPs and PAs at the full rate instead of at 85% of the MD rate), more and more retail clinics are opening up, and most primary care offices employ NPs. Now there is a possibility that NPs will be able to sit for a similar exam to the medical licensing exam.
With position statements like these, it's hard for me to not take on an us vs. them mentality, statements like these put people on the defense...or at least it puts me on the defense.
http://www.acponline.org/advocacy/where_we_stand/policy/np_pc.pdf
This is a position paper by the American College of Physicians on the Use of Nurse Practitioners. Embedded within are all of the insecurities that ACP has about NPs 'encroaching' on physicians work. They repeatedly state that MDs have more extensive training (I don't think anyone in the NP world argues this point, but the MD side constantly states this) and that NPs should not be seen as a way to replace physicians.
I see this as a lot of double talk. The article acknowledges that very few med students go into primary care which is how the NP role sprang to life, along with PA's in the 1960's. It goes on to say that NPs provide an invaluable service in rural areas and areas where medical needs exceed demand. Then it also says that the NPs shouldn't be replacing physicians and that they should merely be an adjunct to the MD. They also seem to say about a dozen times, that NPs should not practice beyond their scope, but then they also go on to say that NPs can meet 60-90% of needs in primary care so it would seem that they are acknowledging that primary care is within the scope of the NP's practice, right after they fretted about NPs practicing beyond their scope.
They state how patients that have NPs may have better outcomes than when they see the MD, but then go on to poke holes in the study that found this to be true. They state that NPs are nursing and MDs are medicine and that they are practicing two different arts and that certification exams should be drawn from each background, but yet state that they are not opposed to a NP centered health care team in addition to the physician centered one but that the NP team must be held to the same standards as the MD centered team although they are quick to say in other parts of the paper that NPs and MDs are different animals. If they are truly so different, why should the same standards be used to measure the success of the NP led team?
As early as 2012, the DNP certifying exam could be a close relative of the US Medical Licensing Exam, which could show the MDs that NPs can also pass the exam. Needless to say the AMA and ACP both do not want NPs sitting for the MD medicail licensing exam since some MDs have long held the belief that once NPs take the same certifying exams that MDs take, they will be treated as true colleagues. With this possibility approaching, the AMA and the ACP have put out position statements saying that nurses should not be taking a medical licensing exam, they should be taking a nursing licensing exam. One could theorize that the AMA and ACP are afraid of the success rate of NPs taking a medical licensing exam so they oppose the use of 'their' test.
All of these leads me to believe they are running scared and noticing that Medicaid is recognizing the NP as a primary care provider (there is a new bill now which would require Medicaid to reimburse NPs and PAs at the full rate instead of at 85% of the MD rate), more and more retail clinics are opening up, and most primary care offices employ NPs. Now there is a possibility that NPs will be able to sit for a similar exam to the medical licensing exam.
With position statements like these, it's hard for me to not take on an us vs. them mentality, statements like these put people on the defense...or at least it puts me on the defense.
Friday, January 30, 2009
Busy Week = Busy Weekend
First of all, I wanted to post the list of things I saw in my first day in clinic, it's not going to make sense to anyone but the nurses that read this!
1. ?staph infx, CP
2. abd. pain, s/p RF, nausea
3. CP, rash, active TB
4. sinus pain, tympanic effusion
5. general f/u, decaying tooth
6. diarrhea, muscle aches, fevers, enlarged cervical LN > 3cm
7. prostatitis
8. ? PE
So I have made it through week 1 of 15 of working 50+ hours. I couldn't get anything done after work each night so I now also have a full weekend to do all of the things that I normally would have taken are of after work. This morning, I went to the gym, went to Target to buy a box so I could ship back all of the unneccessary textbooks I was told to buy and then told that the syllabus had been updated and none of those books were on it, went to the post office and waited in line for 20 minutes only to find out that since my package had postage due on it once it arrives at Amazon I needlessly waited in line with a box heavy enough that my arms still ache, went to the library, came home and ate lunch, took a shower, washed the rugs, cleaned our bedroom (dusted and swept), and am now about to make lasagna. Why you ask? We are continuing our dinner rotation with S and A and this time invited another couple to join. They're arriving at 5 and both have kids that must adhere to a schedule so it's time to get cracking.
1. ?staph infx, CP
2. abd. pain, s/p RF, nausea
3. CP, rash, active TB
4. sinus pain, tympanic effusion
5. general f/u, decaying tooth
6. diarrhea, muscle aches, fevers, enlarged cervical LN > 3cm
7. prostatitis
8. ? PE
So I have made it through week 1 of 15 of working 50+ hours. I couldn't get anything done after work each night so I now also have a full weekend to do all of the things that I normally would have taken are of after work. This morning, I went to the gym, went to Target to buy a box so I could ship back all of the unneccessary textbooks I was told to buy and then told that the syllabus had been updated and none of those books were on it, went to the post office and waited in line for 20 minutes only to find out that since my package had postage due on it once it arrives at Amazon I needlessly waited in line with a box heavy enough that my arms still ache, went to the library, came home and ate lunch, took a shower, washed the rugs, cleaned our bedroom (dusted and swept), and am now about to make lasagna. Why you ask? We are continuing our dinner rotation with S and A and this time invited another couple to join. They're arriving at 5 and both have kids that must adhere to a schedule so it's time to get cracking.
Wednesday, January 28, 2009
Two Sets of Rules
Another example of a double standard aimed squarely at the nursing profession. As you know, I work in a teaching hospital where students of every kind are just about in every setting. My own clinic is home to NP students and MDs in training, not to mention fellows. It was suggested by the powers that be that NP students be limited to one per semester but there are more than a handful of MDs at various points in their training process in the clinic on any given day, let alone semester. Why the contrast? Why is there one rule for NP students and another for MDs?
Monday, January 19, 2009
Nursing Misrepresentation
I was just watching 30 Rock and was dismayed to see that Salma Hayek's character who is a nurse, remark that if she couldn't keep her private duty job she would have to go back to working the night shift at Dunkin' Donuts.
Does anyone else see this as insulting? This implies that there is no skill or training behind nursing...so much so that the only other option for employment is a doughnut shop. In the reverse, this also implies that those working the night shift at Dunkin' Donuts are capable and qualified to work as nurses.
I was disappointed to hear this careless comment because I had been given hope thus far with her portrayal as a nurse. There was no typical portrayal of the nurse as a bimbo-esque white hat short skirt wearing nymphet. She was actually wearing scrubs and a stethoscope and was doing exams on the patients. Then this remark.
Does anyone else see this as insulting? This implies that there is no skill or training behind nursing...so much so that the only other option for employment is a doughnut shop. In the reverse, this also implies that those working the night shift at Dunkin' Donuts are capable and qualified to work as nurses.
I was disappointed to hear this careless comment because I had been given hope thus far with her portrayal as a nurse. There was no typical portrayal of the nurse as a bimbo-esque white hat short skirt wearing nymphet. She was actually wearing scrubs and a stethoscope and was doing exams on the patients. Then this remark.
Thursday, December 4, 2008
Inflammatory Drivel
I found this blog from another blog I read....read on for reasons that NPs and MDs don't have a happy coexistence! It's truly inflammatory and I had to stop reading it. The ignorance is amazing. The author is an MD who doesn't think NPs are qualified clinicians because the course and type of education is different between the 2, at one point he even calls NP education a joke. Clearly, he's not going to get a reasonable discussion out of this when his viewpoints are so offensive and he's on attack mode. Obviously, I think there is a need for NPs primarily in primary care...heck...the lure of the almight buck has driven the majority of med school graduates towards jobs in specialties rather than primary care has opened the door for NPs. Interestingly, MDs have opened the door for advanced level nursing a couple times throughout our health care history. Nurse Anesthetists also exist for this reason. Now that they have, there is a fear that we will take jobs from them because we can do it for a cheaper rate which is favored by insurance companies and the level and quality of care is often favored by patients. Read on if you dare.
http://thehappyhospitalist.blogspot.com/2008/12/is-there-room-for-dr-nurse.html
http://thehappyhospitalist.blogspot.com/2008/12/is-there-room-for-dr-nurse.html
Thursday, November 13, 2008
Double Standards
Unfortunately as a nurse, double standards are the name of the game but it just seems that lately it's become a bit more glaring. Two quick examples: An MD passed away a few weeks ago and there was an all user email sent out containing a very extensive obituary/eulogy about the deceased physician listing his/her entire educational background and work history. Last week, an RN passed away and it was listed as item #13 on an all user that contained many other posts. There was no obituary/eulogy. There was one line that stated the details of her memorial service and who to contact for more information.
Without getting into specifics, it was made evident to me that my time was not seen to be as valuable as one of the MDs here. In a nutshell, my visit with a patient was thrown off schedule because an MD was running EARLY, even though I was seeing her at the appointed time and the time it said in the computer. As a result, we got interrupted mid visit so she could see him, by the time she was done I was no longer able to see her for my visit and had to reschedule. The way I look at this situation is that this would never happen in reverse. It would not be ok for an RN to interrupt an MD visit to take a patient because he/she is running early. Therefore, I think it's pretty crappy that it's 'ok' to be done in reverse.
Without getting into specifics, it was made evident to me that my time was not seen to be as valuable as one of the MDs here. In a nutshell, my visit with a patient was thrown off schedule because an MD was running EARLY, even though I was seeing her at the appointed time and the time it said in the computer. As a result, we got interrupted mid visit so she could see him, by the time she was done I was no longer able to see her for my visit and had to reschedule. The way I look at this situation is that this would never happen in reverse. It would not be ok for an RN to interrupt an MD visit to take a patient because he/she is running early. Therefore, I think it's pretty crappy that it's 'ok' to be done in reverse.
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