Tuesday, November 10, 2009

Kick Against the Pricks: dOCTORS iN sHORT sUPPLY

I love kicking ass on allnurses.bomb. An article shows up stating a fact that Nurse Practitioners are going to be in higher demand soon to come. No fucking shit. All of America is about to get a free insurance card to score Vicoden, endlessly.

Wait...Here it comes...Uh.Uh. Rant: Has anybody in Obama's government spoken to a single healthcare worker on this new healthcare shit?

Let me make a prediction RIGHT NOW:
When everybody gets insurance there is going to be a tidal wave-no fuck that- a goddamn epidemic of opiate abuse. Maybe even Adderrall speed abuse. Instead of going to the streetoofr oral candies, the people are going to figure out what to say to the NP to score. Here it comes America. If you thought our appetite for illegal drugs was bad-wait till you see how truly fucking obese we are when it comes to LEGAL DRUGS!
Rant finished-

So anways I'm a kicking ass on allnurses.bomb. Some dorky little troll pops on and tries to say that tired absolutely bizarre and insane argument that doctors are inherently smarter, they spend so many more hours on the floor (which is always a rather naive argument cuz everybody knows residents walk around in a sleep deprived, stoned stupified daze for the bulk of their training). Nurse practitioners are so stupid we couldn't figure out, we are simply utterly incapable of sending out for referral. So all of our patients are going to die. Here's the link.

I've also kindly provided you with the text. Seriously, I should have been a goddamn writer cuz this little letter (I still call them that) is a whopper. Even my response on allhearses.barf has been good.

I know this post is way too long but I expect more out of you, my readers. I know you can handle long posts. But the post is also about my impressions as a new E.R. R.N., into how my first days as are going (Gulp!):

"I paraphrased you there but the problem with your logic comes from what appears to be your obvious inexperience. The primary flaw in your logic is is the fact that despite the numerous hours of experience med students and residents put into their training, the quality of their care is often comical. How often do I see med students and residents standing around, gossiping, studying? Completely oblivious to the goings on around them? How often are they really part of the hospital team? Not much. Just because you are inside of a hospital doesn't mean your are learning anything that is actually useful. Massively piling hours up sounds like a recipe for incompetence to me.
Since very few doctors have ever gone to nursing school and most to this day truly don't know what a nurse actually does, the unknown fact is that nursing school is at minimum a two year crash course in how TO RUN A HOSPITAL FROM THE GROUND UP. On the flip side, nurse's have to know what a MD does to do their job. MD's frankly consider 90% of the necessary functioning of a hospital someone else's problem. This makes MD's weak and ineffectual. I find med students and even up to R2's utterly clueless on how to contact the resources available to them (i.e. lowly custodial staff, dieticians, social workers) to efficiently wrap up a case and help expedite a patient's care.

In addition, I regularly meet physicians with numerous years of experience who find that when other members of the team ask them to do something a certain way, like writing orders, to follow the standardized procedure, they simply will not do so. The primary reason why MD's are so spectacularly ineffective in their roles is their utter arrogance to admitting the fact that 1) other people are as important as they are and 2)that every time a physician decides to do things "their way" it costs untold man hours to rectify the problem and get the patient back on track.


When a nurse decides to transition into the practitioner role, if in their practice they are treated with the same professional respect as MD's I have found them to be far more effective, getting the job done with out so many displays of tantrums and blatant disregard for the job everyone else has to do. MD's have the luxury of being told they are so very very important from day one. Nurses are taught we are not as important from day one. We have learned to diagnose and treat in a round about way, integrated into our standards of practice so as to not dare cross over into the "medical" model and dare speak a diagnosis. As if what nurses do isn't "medical" from the second we step into a hospital. Being trained "in the medical model" doesn't make you a jedi warrior, it's hilarious when a M.D actually brays that from their lips. What nonsense.

The bottom line is that this change in roles, this impending tidal wave of need has been brought on by doctor's themselves, who for the last 60 years have been running around touting their incredible powers of mind and yet have been in fact, accomplishing extremely little.

Prime example: Last night I worked registry in a local E.R. The on staff, full time physician ordered a bladder irrigation for a patient, s/p bladder resection from bladder CA. Large amount of spraying blood, gross hematuria, fair amount of blood loss. M.D. refused to consult pt's urologist. I asked the wife to call. She did. We did this without E.R. M.D. knowing.

E.R. M.D. didn't know what type of fluid to use for irrigation. Didn't know how much. Didn't know how fast. Wasn't worried about blood loss. "Have to get the clots out" was his mantra.
Didn't want to pay to have coags drawn. Didn't want to type and cross. Patient nearly died. Pt didn't die because I: 1) drew coags, drew type and screen and broke the rules when I put two on cross later. 2) I called a darn urologist cuz I didn't want the patient to bleed out. 3)I started an 18 guage IV without permission. 4)I demanded he get a uro consult. When uro consult came he admonished moron doc in front of all of us and 5)pt was rushed to or where HE DIDN'T DIE. Doctor didn't thank anybody, was oblivious to THE HOURS OF MANHOURS HE wasted when it took 5 RN's to get the show on the he road and get the work done. AND THEN HE PROCEEDED TO ATTEMPTED TO TAKE CREDIT FOR THE WHOLE SITUATION IN FRONT OF UROLOGIST WHO THEN ADMONISHED HIM. THIS IS A REGULAR OCCURRENCE. I was expected to clean up an incompetent doctor's mess.

I can tell you, no med student on earth would ever, will ever, know how to handle that situation. A nurse with one year of experience will. Your argument logically looks great, just like a nice lab coat and a clean pressed shirt with a tie. But the argument is own by the reality of what happens, day in and day out in every hospital in America. No matter how smart the doc is, they simply cannot fix all the problems with any level of efficacy that they think they can.
And I'll tell you something, because of that experience, because of this article, so help me god, I'm going to NP school. And in three years I'll be healing people the right way, with HUBRIS, but I will not hesitate to take or give credit when it is and where it is deserved."

Okay Licensed to ill fans- check out this young reader reply:

"Old Today, 12:32 PM

Default Re: Doctors-in-short-supply-responsibilities-for-nurses-may-expand
Originally Posted to sonnyluv View Post
WOWOWOWOWOWOWOW!!!!!!!!!!! probably one of the most amazing posts I have ever read, on any subject/topic or discussion board, hands down. Period. I'm not even a nurse (yet)...and you have rocked my world!!! You will be a fabulous NP...best of luck to you. "

No shit, friends. I rocked her world. It appears she had some kind of literary orgasm. I love changing lives.
Off to therapy!