It Eats Raw Meat

Now I'm no boxer, not much of a fighter. I'm an unemployable loud mouth knowitall know too much dumbass jacked up to the grain R.N. but...

This speaks to me:

The great cornerman BUNDINI maybe once said:

"God don't care about you! Don't

care about me! In all of everything,

we mean nothin'. He don't know us.

We be.

And that's the onliest

thing he did.

And that's good

'cause that's why we free. But

free ain't easy.

Free is real.

And realness is a motherfucker...

It eats raw meat.

It walk in its own shoes.

It does not waver...

Yeah..."

Fuckit, if it takes boxing movies to get my soul back in gear, well then, that's what it takes.

Death of A Star

"Tucked In"

By Licensed to ILL

Good white Soul

Righteous indignation

Carnage Deluxe

A Symptomatic Soul

Watches the Elite Burn

Saying Goodbye

Saying Goodbye

Saying Goodnight

Let's put ourselves to Bed

Peer Out over the Covers

Soak the sheets with Our Sweat

Baby's Dream is Baby's Whispers

Loving the Sweetest thing

It's okay to Say Goodbye

Saying Goodbye

Saying Goodbye

Saying Goodnight

I got diagnosed with PTSD relating to a patient of mine who got raped

No one would touch her because she was a dirty homeless meth addict

I told the resident She had a punctured lung

Her left midaxillary chest snap crackled and popped with subcutaneous emphysema

He just shrugged his shoulders

What happened to her?

So my recent co-workers pointed out that I seemed symptomatic.

They told me they were there to help.

My manager fired me three days later.

They saw another nurse who needed help and then they fired me

I no longer live in L.A.

I no longer live in California.

And now I have no job.

And I'm not feeling so good.

Conan the Barbarian

I have left Los Angeles. Moved to a smaller, more chill city. Northern city. Bought a house in the suburbs. Kind of a blue state, kind of a red state. People seem nice. A lot more white people walking round than in L.A. That's kind of weird. Wonderfully color full, diverse pockets but mostly white. It's weird blending in. I like the anonymity. Why do I notice race? I spent my High School years in a predominantly Caucasian area. Spent my entire 20's as a racial minority. It tends to give one reason to pause and reflect when racial makeups around you change as well as pervasive attitudes and outlooks.

How will I be perceived here? In L.A., some people could care less about race. Some people were openly prejudice. Some people hid their feelings until a moment arose when a preconceived notion was activated by some behavior or incident, some conflict that confirmed the belief they thought they secretly held to themselves. Some people were abnormally nice to me because of my race. Usually because they held ill feelings towards another race and would rather associate with mine. Call it racial motivation. Most people don't think that it exists. But it does. Race is the seventh patient identifier and everybody should goddamn know it. The people that did not care about race were the people that acknowledged these feelings existed in themselves and everyone around them and then simply moved on to more pressing matters. Like building a team, making a friend, finding support.

I do not think I was one of these people. I felt too vulnerable. Been attacked physically and professionally too many times cuz in the summer I look like Opie, with all my freckles and red headed step child hair. I always tried to test the racial water first, to see if the person I was talking to believed that we are all in the same boat, that sinking one, called the USS Middle Class, the one with all the working class people, of all different sexual orientations, creeds, religions, colors, hanging onto the side of the boat for dear life. If they knew this, recognized that this sinking boat also served as a trough to be tossed scraps by the uniform One Raced Management. Management is one race: How can I fuck you without telling you? race. If my coworker knew this, well then, I made a friend.

I am aware that I am damaged goods. I am prone to disgruntled status. I've been burned. Left to fend for myself. Didn't have help way too many times. What I experienced on a daily basis does not seem to happen here, in hospital of the insured land, where they want the "customer" to be happy. Everyday I realize that the abuse I took in the name of "trauma" and most likely also in the name of large corporate bonuses was wrong and hurt full to my disposition, my ability to give a shit about my patients. Right now, I'm grieving. I ache for my naivete, for my spen last honest intention, for my foolish belief that my unit supervisor actually BELIEVED IN the mission statement of the hospital. I am mourning over the days and nights my wife and son had to deal with nightmares that I futilely struggled to not bring home. The drama and the disgusting behavior, the utter maliciousness, usually in the name of an older nurses fragile ego, I brought it in right along with the MRSA and VRE, a prescence that no happy home should ever see. I am so sad that I was so right and so naive enough to think that what was "right" had any meaning or impact on policy or behavior.

I left my hospital in good standing. No official writeups or patient harm issues. I worked hard. Did my job. Got a good referral from a supervisor. Took a lot of abuse, in the name of making it through my first year as a new grad I.C.U. nurse in urban hell. I did my time. I paid my dues. Again. But with my dues came the knowledge of how to shut up, what to say and not to say and how, above all else, to keep the mind sharp and decisive despite the thunderous din that 20 A type I.C.U. nurses make as they watch you take on their workload, their trade and pride, acquired with years of experience AND NOT FAIL much to some of the bitter one's chagrin.

I feel like Conan the Goddamn Barbarian. Especially right at the end of the movie, where he sits on his throne, queitly tough from battles, everything conquered, pondering what made him hook up with Grace Jones. Nothing for ol' Conan to do but reflect on moments of war where he showed true grit but didn't even realize he was doing it at the time. Now, I've only finished my rookie year and my conquering days are far from over. I have many many more battles to fight, lessons to learn, plateaus to reach and ascend from. I'm just getting started.

But in this market, I'm a veteran. And really, I'm more embarrassed for what I went through and saw. I'd rather not talk about it. Cuz when one of the experienced nurses here tells "this one time" story it just pales, in the same way my stories paled in comparison the Old schoolers who taught me.

I don't know what nursing is now. Is it an exact field where everybody has all lab values memorized and we practice over and over the documentation and techniques required for conscious sedation? Or is it a field where you have O2 ready, make sure the patient is on monitor, have an intubation kit ready and just keep track of the fent and versed in your head while you pensively look between the patient, the monitor and the Doc? Is nursing duct tape or a text book? Is it hardcore bullshit or is being a critical care R.N. over studied, over trained, alphabet soup CCRN credentials but with insufficient application experience?

What brought all this up, you ask? During orientation a PACU(post anesthesia) nurse told her super intense story about how a 80 year old woman had to be restrained. Okay whatever. For her, it was scary. But later on, when we were talking about thorough documentation in the unfortunate sentinel event you get called to court I told a story about how my charge nurse got choked out unconscious by a crack head who was coming down and wigging out and how hospital management blamed her for the assault telling her, "You should of known better than to tell a drug addict to please keep her voice down and not go into other patients rooms." Management was mad because they had to hire lawyers to impose a permanent restraining order against the patient from ever intentionally coming to the hospital again. She got blamed for even going to court.

My new co-workers were horrified. Jaws open. I could see one guy giving me the "You're so full of shit" look. But I didn't even tell them the whole story. How the crack headed lady skillfully grabbed my balls while she scratched the face off my charge nurse, how ten nurses, male and female dove head first into a brawl with the crack heads family members who immediately accused us of HURTING HER. (Right?) I didn't tell them how the cops came, en masse, five white cops (Of course it's a predominantly African-American neighborhood) billy sticks out and mace drawn, ready to kick some ass-the offended "You pissant" look the Sergeant gave me when I told them to put their clubs away because we had finally gotten the family isolated in a room and they were going to freak when they saw the clubs. I didn't tell them how I wasn't afraid of the crack lady, I was afraid of her 20 year old son, ghetto brawler who slyly stepped just outside the room when we went in (yes you do have eye balls on the back of your head cuz it wasn't Yoda squeezing my sac) and to a lesser degree her husband, right hand in his pocket, gawd jeezuz I can only imagine what lethal weapon was going to come out of that fucking pocket.

The PACU nurse said to me, "Oh my gosh you have been hurt! It sounds like you've had a pretty rough introduction."

Yeah. I am disgruntled. I'm pretty sure I was thrown to the wolves but they only got an arm or a leg.

And I need to get over it, fast because the medical world I'm in now, it may actually be the Disneyland of hospitals. I mean don't worry, I always find a way to be horrifically outraged and crank out master rants of disgust, don't you worry, my literary scoobie snacks will prevail but- I've got to stop mentally wanking on my post scary situation bitterness.

Later the PACU nurse said some very nice, sincere things to me. She told me she was glad there was people like me in the field. She said I seemed like a good nurse. She told me never to take nursing bullshit home. She hasn't worked in five years. She's never been a critical care nurse. She doesn't know.

But she is right. She is right.

We are all here. We are all here.

To Live and Die in L.A.

I have just resigned from my first nursing job for a number of reasons. I gave three weeks notice. Sadly, I do not feel relieved. I feel scammed and ripped off, exhausted and abused. I don't feel free. I'll expound more on that next week. First, I must share my lessons learned so that others following in my footsteps can remain modestly protected. Thick skin is understandably and necessary requirement to nursing, however it appears shank proof skin is more the order of the day.

THE RULES OF STAFF NURSING AS I HAVE COME TO KNOW THEM:

1) Even the "cool" experienced nurses you think you can trust will jab the knife in deep given the opportunity.

2) Everybody has a family and obligations, just like you do, they don't care and as a new nurse, even with identified potential you are still a flash in the pan.

3) Experienced nurses (+8 years) absolutely cannot tolerate being identified as having made a mistake or doing anything that might reveal they are human and not perfect. If you stumble across a nurse who say, has proudly announced that she thinks restraints are unnecessary and cruel while her patient is now holding their yanked out portis subclavian central line DO NOT WANT YOUR HELP

4) An experienced nurse who suddenly befriends you has fucked up amongst the other older nurses and is using you as a surrogate friend until the old guard accepts her back.

5) If you ask for help from an experienced nurse and actually receive it, the service comes at a cost: they will then take credit for all of the work you have performed on the shift until that point, with no shame. NOTE: The exception to this rule is older male nurses. I don't know why but they seem pretty stoked when anyone will just listen to them.

6) If you are suicidal enough to point out an error in logic, intervention, or treatment with an older nurse dumbly thinking they will appreciate this then you will forever be labeled as a "know it all" and "dangerously arrogant" despite the fact that usually, the only patients dying from lack of informed and or supervised care is their own. (Hence the constant phrase: "oh, but he was old")

7) Sadly, the one way to break down most fucked up nurses is to ignore them and be openly hostile. I myself hate behaving this way, it makes me feel dirty and sticky in my soul but after a month the same nurses that would literally ignore a question to their face will be hugging you and be delighted to see you.

8) Escape into patient care and knowledge. When in a confined environment surrounded by jackal infidels the only place to go to is work. Might as well do it well. Do not ask questions from senior nurses as they are inherently insecure and confuse genuine curiosity as an inquisition and threat. One question too many may shatter their fragile sense of competence.　REMEBER QUESTIONING IN NURSING SCHOOL? IT WASN'T ABOUT WHAT YOU KNEW BUT HOW WORNG YOU WERE. The field hasn't progressed, trust me.

9) It's a great idea to make allies with interns and residents, usually because they relate more to younger novice nurses than older snappy ones and working together to help a patient becomes an effective, educational , and rewarding experience.

10) If the older crew see you relaxed and making jokes with physician staff they will call you "lazy" and will accuse you of ignoring your patients despite the fact that is exactly what they are doing when gossiping about you. Never mind that. Nobody wants a letter of reference from an old crabby nurse who treats the latest evidenced based research and knowledge with the same disdain as she would the newest thrash metal album from Slayer. She aint buying it.

I wish instead of a LA TIMES 20 part news story about 80 whacked out nurses and how they have fallen through the cracks of diversion,　I 'd like to see a story on the tens of thousands of tax paying Californian R.N.'s who get regularly scammed and shorted on their paychecks by gloating big bonused hospital management. (Again next weeks topic)

I feel fucking violated. Not only were their staffing ratio's absurd, but when I found out how my new hospital staffs their ICU I got choked up. Seriously, I choked up.

Patient with a balloon pump: 1 to 1.

Patient on ventilator with ANY pressor going:1 to 1

Patient on CRRT: 1 to 1

Patient returning from any invasive emergent cardiac procedure:1 to 1

Seriously, it made me cry. I've had assignments so unbelievable and harrowing while three morbidly obese shit talking multiple personality snackers loudly predicted any possible negative outcome to my patients. ONE TIME IN A YEAR did I have a 1 to 1. Septic, over 300 pounds, active MI, central in groin and central in R IJ, Multiple blood products, fucking 14 PUMPS! NO shit. At 0430 the supervisor literally grumbled all right, make it a 1 to 1 at which point my other co-workers literally stopped what they were doing and demanded I thank them for RECORDING THE VITAL SIGNS ON MY OTHER PATIENT.

Friends, I have had patients code during report and then been barked at by my supervisor for taking too long to get report on my second patient.

After the interview at my new hospital. I, a man, a dude who is semi-permanently disgruntled, prone to the negatives, a man who relishes the positives when they come, a nurse who gives a shit about his patients because it is the only way to stay sane and true of heart, a father, a husband.

Well, I cried.

I cried for my exploitation, I cried for my patients who got just -enough-to -keep-you-alive-care night after night. I cried for the thousand and thousands of times I signed my names to documents that no one will ever look at, selfish documents to cover some lawyers ass that took unreasonable time from patients rotting with bed sores and their own shit. I cried for my co-workers who just don't get how disgusting it is that one ICU manger can cause so much human suffering and distress to get a fat bonus. Cuz that's the bottom line and it always will be. If you need someone to create abrasive, unethical policies that save substantial money in an environment that requires vast resources, well your soul has a price.

The last few weeks I have been blaming foreign nurses. But I may be wrong. I don't know. I do believe foreign nurses don't bring a whole lot to the profession as a whole. I think they inadvertently bring standards down to the standards they are accustomed to.

• My new unit has no foreign nurses. Not one. 60% of the staff R.N.'s have CCRN certification. As opposed to NONE in my last I.C.U with 20 more beds , a staff of 60, and most nurses with easily over 10 years experience residing in a level two trauma center. I will never hear report in Tagalog at my new hospital. My supervisors will communicate in English.

I hope that the racial divide that is burning like napalm in nursing will not be present in my new unit. I hate how discussing the fact that foreign nurses is in no way good for American nursing is considered racist.

I have left Los Angeles. I have left my home state of California. Surprisingly, the money is better in a more affordable state. It appears, on first glance, the care is better. It also appears that the treatment I will receive as a professional R.N. will be commiserate to the demands and complexities of my job.

This all, of course, on first glance.

You fucked up, you REALLY fucked up.

FUCK YOU BRN-NOW YOU HAVE SOMETHING BETTER TO DO THEN HARASS NURSES WHO HAD ONE TOO MANY WINE SPRITZERS.

HOW ABOUT CHANGING NOT JUST WHAT NURSES DO BUT WHAT OUTSIDE FORCES DO TO NURSES?


Man I wish the media would come up with a better tag line than "due to the ever increasing nursing shortage this hospital now has...."

From there we fill in the blanks: "Due to the ever increasing nursing shrtage this local hospital has..."

• Happy go-lucky MALE NURSE perverts working for them.


• Drug stealing junkieusers working for them.


• Shameless overpaid nurses on overtime falling asleep on the job recklessly killing patients and laughing all the way to the bank.


• A male nurse who molested every single female who came into the 500 bed hospital and managed to used the prolapsed anus of a 90 year old woman as a cigarette holder for him while he peed on her dog as he was insanely high the very last pills of ambien and colace she had,etc.

It's never real shit like: nurses don't get breaks anymore, management harasses R.N.'s who have a conscience, nurses seem to be making LESS money despite this incredible shortage...

As a R.N. I see nurses everyday who shouldn't be practicing in a perfect world. Some because of their atrocious attitude towards patients (burn outs), others with obvious mental problems who probably wouldn't be safe to handle fries at Burger King (related to traumatization and abuse on the job), and some who simply came to this country to make more money then they could in their home country. (sorry Pinoy but 6 out of 7 of you guys do a disproportionately large amount of the fucked up shit I see. Your ambivalence towards human care is as horrifying as it is somehow culturally ingrained)
There is no nursing shortage in the U.S. That's nonsense propaganda created by hospitals to get cheaper foreign labor. Only hospitals that are so hellish in their treatment of nursing staff have staffing problems and experience a "shortage".
The AMA and hospital associations have enabled tens of thousands of nurses to come to this country from other countries for the sole purpose of making money on cheaper, more obedient labor. These nurses not only leave their home countries in a void of health care but also leave American R.N.'s to take up the slack. At least four of my coworkers don't speak English adequately enough to carry a conversation but know how to perform medical tasks. Some were able to take the licensing exam in their native language. I am constantly covering their butts just to make it through the shift. If I were to complain I would lose my job, union or not. I would be called a racist. A hundred years ago they would have called me a "nationalist" but nobody knows what that word means anymore.

Nursing is an unbelievably complex job that is constantly being put down by media, hospital administration and physicians. So many nurses have drug problems because the people who take care of you HAVE ABSOLUTELY NOBODY TAKING CARE OF THEM.
The article that led to 6 out of 7 BRN members getting tossed on their ass demonstrates how absolutely crucial the job the R.N. performs is.
The effectiveness of the BRN is severely limited because the BRN is inundated with three types of complaints: 1) My nurse doesn't speak English. 2) Hospital managements lodging erroneous complaints against nurses in retaliation for sticking for themselves and their patients. 3) Complaints filed by hospital management to cover up mistakes of arrogant physicians.

The largest reason the BRN sucks is because its staffed with hacks and non-nurses. Go figure! Political payback is tasty.

Nursing practice has changed so much in 20 years- the job that older nurses were trained to do simply doesn't exist anymore, nursing is truly not "nursing" as people know it. It is an incredibly complex, demanding, and intensely challenging job that requires dedication and- the nursing profession still doesn't recognize this- it requires talent.

Nurses are treated so poorly by physicians, hospital management, and most certainly the patients that they treat that a dangerous nurse is easily overlooked because everyone walks around in the medical field thinking "another dumb nurse did this".
True bad eggs like the ones in the article would be cracked and disposed of more quickly if quality nurses were recognized, and nurses who have no business being in the field were rooted out.
Bad nurses get away with it because, frankly, it seems that the public is quite happy with the stereotype of nurses being angelic, mothering, brainless assistants.
I don't think the public or the media comprehends the importance of the nurse in the disease and healing process from a technical and clinical standpoint. At all.

Right now, bad nurses run the show. The pathological liars, the borderline personality disorder bullies, the perpetually immature 14 year old girls breaking hospital units down into clique war zones. Right now, everything that is wrong about nursing rules the roost. Nobody complains about anything that means a fucking thing. Nothing about patient care, nothing about pay, nothing about safety, nothing about the blatantly redundant paperwork. Everyone feels like they can't change it so on Tuesday lets gang up on Tina and whisper behind her back and start some shit. Then we'll complain that she was mean to her patient, "no it's true, she was soooo mean to her patient cuz I was on like priceride.com getting a hotel room for vegas so I like heard everything..."

Oh well, tonight I sleep good. For the first time in many moons, the nursing gods have hurled in some political 18guages that pull blood out like central lines.

One thing Leads to Another

One thing led to another, that day in the late afternoons of early summer. Holding hands on an unchaperoned date led to heavy petting which then led to some very heavy anal sex.

That little toke off that marijuana cigarette led to IV heroin with dirty needles. Like shooting hoops on the city court with some friends leads to the Lakers winning ANOTHER goddamn championship (along that plump vein- a team winning a championship leads to numerous cars getting rocked off their fucking shocks and stores burned wide open). Billy shooting a pistol at the Beverly Hills Gun Club leads to Arnie "Ahmadinejad" Iran posessing nuclear weapons. Like sending your kids to college leads to Bernie Madoff, like telling your Mom your love her leads to homosexuality if yur a dude, lesbianism if you're a chick and it's yur dad. One thing leads to another. One small thing leads to the motherfuck of all things.

Pre-WWII German's wanted government subsidized healthcare and ended up with six million jews dead, 3 million of them doctors so that fucked that whole thing.

An enthusiastic go-getter of a Jedi, Anakin Skywalker, thought he was being passed up for promotion too often so he turned into Darth Vader.

It's a scary fucking world.

A few weeks ago a pharmacy tech at Long Beach Memorial Hospital in Long Beach California killed two employees (both of whom were his managers). I used to work at that hospital and I knew that man. Not well, but it was he who handed me my first few bottles of legal speed, Adderall. One pill of Adderall leads to a blog called licensed2 ill.

Management at Long Beach Memorial is positively viscious. Disgusting. What did it take for him to snap? How much dignity did they make him dole out in handfulls before he found out that they were going to ditch his already overworked ass. One thing leads to: BOOM!

Last night my patient was an 88 year old man. Shortness of breath leads to intubation> leads to sepsis> Leads to ARDS> Leads to sedation with fentanyl and versed>leads to levophed> leads to CPR> leads to death.

But lets back up. This 88 year old man happened to be one of house anesthesiologist's father.

Here's the kicker: She wanted everything done to her pop possible to save his life despite the fact he was a DNR. Do Not Fucking resuscitate Under Any Goddamn Circumstance unless you want to lose your license, get sued, go to jail. But when push came to shove, and even though the old man had the DNR because he saw his wife go the same way a few years ago and a) couldn't live without her and b) didn't want the same treatment. But when the time came and death grabbed the old man by the ballz the daughter, Dr. anesthesiologist did what she could only do in a moment of grief. Jump in and intubate his demented ass. (He may have dementia as well no one knows). Fuck me.

Here's the other kicker. The two pronged double kicker: She is an anesthesiologist-the stoner of medical specialties-she orders no sedation, no pain meds, nothing to make him more comfortable. Father is totally on ventilator, restrained, cannot move shitting in bed with not a single opiate or benzo for his ass. For those of you who don't work in the field, being awake on a ventilator has got to be one of the most hellish and violent experiences a human being could go through. A machine tells you when to inspire and expire, every hour some dipshit like me is sticking a tube deep inside your lungs to suck the mucus out. It is excruciating. But no pain meds. Per her strictest orders.

So at 0400, after asking him 20 times all night if he was in pain, each time he said yes, each time I asked him if he wanted pain meds he said no, I said is it because of your daughter he said yes, I said does it feel good when I have to reposition you every two hours he shook his head no. Enough.

Enough. I could help but feel in my heart to the it of my gut, my son, my two year old in thirty forty years making this decision. Me old, sick, dying in bed. My life, my youth robbed from me by the same clock that has taken it away from all others. A selfish scary view of mortality that keeps knocking me upside the head, more and more lately. Enough. MY sweet boy. Her father. His age, his eyes, they looked like the anesthesiologist's eyes, his nodding and shaking his head. MY job. My license, my beautiful wife. Her body is still young, so is mine I guess, HOW LONG HAVE WE GOT?

But here's the second part of the kicker: He came in filthy with bed sores all over his body. He was being neglected at home. He had over nine documentable wounds - wounds severe enough we had to document them with pictures on his 88 year old body WHY KEEP HIM ALIVE WITHOUT PAIN MEDS? Enough. I called the intern. Gimme morphine for the old man. Hell no the intern said, it was his ass. Give him tylenol intern tells me. Fuck you Brian. I gave him tylenol. It didn't do shit. Silence. 2mg of morphine slow as fuck. Thank you. Done. I gave it like sloe gin joe. He slept for the first time in days.

Jesus on vent, nailed to the Hill-ROM ICU bed with nothing for pain or sedation. The next day he did so well on his CPAP trials he was extubated.

How did his daughter know? How sick is it she knew the drugs of her own trade, given in our protocol doses would have killed him, kept him from getting better.

How did she know there was a lonely isolated male nurse taking care of him who eased his own futuristic uneasiness by medicating her pop. Whatever. That's the second time I've seen a train wreck come back when the physician parent declares a "no opiate rule no matter what" with the patient and a miraculous recovery is scored with in days. Like going from your deathbed to cooking breakfast for every nurse in the ICU.

God there is so much I don't know, like waking from the nightmare in a room with your eyes open but its still too dark to see.

Like Ben n' Jerry's Cherry Garcia leads to morbid obesity.

Like depression and burnout lead to apathy and disgust.

(I know the holocaust joke is a bit much but goddamn it people- the shit I see- thie shit I see)

AMA makes me go AMA (aint got nothin' on me)

http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm

I posted this response on allshmurses.com. The AMA is pissed that the new nursing doctorate program exit exams are touted to be as challenging as the third level of USMLE. Seems MD's are worried that these fake doctor's will obtain REAL doctorates, then call themselves doctors and thus will give physicians a bad name by providing excellent care, actually listening to the patients, and actually giving a shit. Outrageous.

This is a long post- my posts always are- that's how I roll- but I'll end the argument right here.

This one is important. I think the DNP is waaaay ahead of itself. Certified nurse specialists are hardly recognized. I work on the floor with N.P.'s who are kicking themselves because the payoff for 20K to 40K in loans and two more years of time and effort has been NOTHING. Having a BSN's doesn't guarantee diddley squat professionally, either. I don't think R.N.'s need a doctorate to prove their worth. It's like an industry wide lack of self esteem. The ability and potential of a minority of educated and motivated nurses is like medicine's dirty little secret.

"Medicine decries nurse doctorate exam being touted as equal to physician". Uhhhh-so what if it is? There are many different kind of nurses. Many different kind of doctors. Lawyers. Sales people. Pool cleaners. Judges. Some people in their chosen profession choose to take it as far as they can. YOU WANT TO ENCOURAGE THESE PEOPLE. Some nurses I wouldn't even let take care of my pet turtle. Same goes for everything. So what if the exam is equal to the USMLE?

Whenever I talk about my job people ask me if I'm a doctor. I proudly tell them "no, I'm a R.N."- I usually get a quizzical look implying the person asking the question thinks that if I'm not a M.D. I must hang around slinging bed pans all day, their look clearly says: "Why is this guy talking about HIS patient like he makes decisions about their care?" So I politely explain that M.D.'s make disease diagnosis and are in charge of plotting a course of treatment for the patient. I explain that is is my job to not only understand the course chosen for treatment- but I am the one who institutes the treatment and I manage it's physical run. Yes, doctor's prescribe medications and order diagnostics. But in my I.C.U. they sure as heck don't give medication. I start the I.V. I give the medications, I assess the patient and if anything goes wrong I need to catch it before it happens and give the doc a heads up so they can re-plot the course of treatment. If this is not true then why do I need to have a license? Why am I held accountable for an adverse reaction to treatment or a change in patient status?

Last night- I admitted a patient from the E.R. with a primary diagnosis of pneumonia, c/o chest pain-with an extensive cardiac history. The cardiologist who ordered the admit had full privileges at my hospital as he was standing in for an intensivist who had a family emergency. The cardiologist was responsible for the admit and all other standing orders. Other than the insurance the patient had, the cardiac history, and the fact that the patient had received nitro and morphine in the E.R. the cardiologist didn't know anything abut the patient OR WHAT TO DO WITH HIM. He had no clue how to address the possible pneumonia and or sepsis. (Apparently he hadn't heard of Joint Commission)

So I walked the cardiologist though activity, diet, fluid type and rate, antibiotic regimen and all other diagnostic procedures to rule out sepsis. I wrote the "orders" as I gave them with his consent. Apparently the patient had thrown up in the E.R.- I asked for an anti-emetic-all I heard on the phone was,"uhhhhh" So I suggested a medication with rate and frequency. I asked him for cardiac parameters. The cardiologist asked me how the patient looked. I gave him my the results of my cardiac and pulmonary assessment. He thanked me profusely, gave parameters, and kept apologizing that he was just moonlighting, he hadn't done this in a while.

He asked me for my interpretation of the chest xray.

I told him "Sorry, out of my scope." But I had seen bilateral infiltrates in lower lobes when I read it. So I again encouraged that we follow the sepsis protocol. No problem. It was nice that he was pleasant. But when push comes to shove-yeah, M.D.'s don't find the R.N.s so incapable after all. And then I began the paperwork.

Later that night, the attending came by and said, "Wow! Dr.--- can still write ICU orders like he works here everyday." I'm not a doctor. I sure as heck don't know as much as one. But how much education combined with clinical experience do I need to know as much as one? No doubt, a lot. As a brand new nurse I got chewed out by the attending physician right along with the interns and residents for flubs that we all should have caught.

You see, it's role reversal, plain and simple-without the exchange of authority. I want to learn more about the disease and cures while many of those interns, now residents, want to develop their bedside manner. Seems the smart ones have figured out that it increases the odds of a better outcome to be able to communicate with one's patient. Nurses learn this immediately. Some doc's never get it, or care to. In my opinion, they are the ones who are doing the most damage to physician's. Not a DNP. It appears that the few nurses who choose to pursue advance training, pushing the envelope of our assigned role is clearly terrifying to M.D.s. Perhaps a bit of "man behind the curtain", huh?

They can call us dumb nurses, wanna-be doctors, whatever. MD's know very well that as treatment becomes more rapid, more complex, more demanding, nursing education is becoming a dynamic new modality in itself. If I don't understand or anticipate treatment then I am useless.

And as frightening as it is to the A.M.A., I am rather inclined to learn as much as I can about the science behind my work so I 1) don't hurt my patient 2) continue to bring enthusiasm to my career. That may include advanced degrees. And I'm gonna say it: In my area of specialty, it certainly appears that experienced and well educated R.N.s know absolutely as much as physicians do, in that specialty area, and physicians know it. Much in the same way a cardiologist doesn't know what to do with an admit. You want evidence to back that statement up? Ever watch a new intern ask an experienced nurse a question? Tell me who is giving "orders" to who. What doctor hasn't been shown the ropes by a R.N. at some point? From the basics "he needs a fluid challenge" to "write an order to start a levo drip at 20mcg/min and start a central!"

But to know as much as an expert, takes a combination OF YEARS and education. Expedited by education but you can't be an expert without some serious time laid out.

According the the A.M.A.-this is simply impossible.The A.M.A.'s argument is essentially,"If you didn't start your career with a M.D. then you can't ever be as capable as one." Look how they treat D.O.'s? Childish. The truth is that the A.M.A. is concerned with the bad publicity they will receive when advanced nurses start taking the equivalent of the USMLE. THEY WILL DO OUTSTANDING. Nothing like the motivation of those with something to prove.

Example: My old hospital was a teaching hospital affiliated with a major university. It has a C.R.N.A. program. The S.R.N.A.'s have to retake anatomy and physiology along with the med students. Scores were posted in doctor's break rooms. Most of the med students pulled C's and D's. The nurses all scored above 80%. The hospital promptly stopped posting scores in the break rooms.

This is a turf war, plain and simple. MD's can't operate without us. Let them waste their time fighting nurses. Nurses don't fight for turf with doctors. We fight for respect and autonomy. Meanwhile- insurance companies- the real turf monster, are wiping the floor with what used to be the physician's salary and medical authority.

IT DOESN'T TAKE A DNP TO PROVE "M.D. level" COMPETENCE. ALL NURSING NEEDS TO DO IS INSIST ON RECEIVING CREDIT FOR THE WORK WE ALREADY DO. SPREAD THE WORD. WE ROCK.