Another day, another nonsensical battle among health care peeps for who is the biggest douchebag. This is TribeTalk, so hide the kids and cover grandma’s ears BECAUSE IT GETS REAL.

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28 Responses to ““Nurse Practitioners are DUMB AND I HATE THEM””

  1. Debi Onken

    Collaborative yes; supervised no. About half the country allows NPs to have full practice authority (practicing at the top of their licenses) and the patient outcomes are no different than the more restrictive states. Of course medicine should be collaborative – but why does this have to legislated? Physicians are perfectly capable of being collaborative without having it legislated – is there some reason why NPs wouldn’t also work that way without laws mandating it? Supervision has an entirely different meaning and frankly doesn’t actually occur so this is a complete red-herring. It’s especially difficult when MDs say “collaborative” model, because what they mean is “I’m the captain of the ship and the rest of you are my crew.” Lots of people don’t know what they don’t know and that includes physicians, do you propose that only non-physicians “don’t know what they don’t know?” (And by the way, you really should be using the term physician, not doctor.)

    Reply
    • Joe Paczkowski

      The question is what’s the functional definition of collaboration vs supervision?

      “Hey, I’m not too experienced with this type of situation, what’s the ideal way to approach it?” is collaboration. These situations ultimately fall under the responsibility of the provider and the person curbsided should never be documented… unless it’s a formal process like a tumor board or cath conference.

      “Hey, can you review/sign my chart and take even a little liability if things go South?” is supervision, regardless of if it’s only done to increase reimbursement.

      Reply
      • Debi Onken

        Very true. Supervision then rarely actually occurs. Which is why the connotation is there but the actual supervision is not. Again a red herring.

        Reply
  2. Deborah Sorgen

    17 yrs critical care RN. Auto-didactic training in all body systems, physiological derangements, normal and abnormal lab values, cascade of organ dysfunctions etc. Neuro,endocrine,exocrine,cardiac,pulmonary,gi,renal,hepatic,hematology, autoimmune- no interest in ob-gyn,peds,nicu. Estimate minimum 16,000 hrs self study.
    Have seen 5 doctors in that time that understood the relationship between magnesium, calcium, chloride and potassium levels- and who did not just keep replacing potassium without optomizing mag,ca, or chloride deficiency alkalosis. This is just one example of general practitioners and hospitalists in intensive care. So sometimes, working to your highest level doesn’t automatically mean, the highest degree wins. The things I’ve seen! The things I know! Create a daily heartbreak. I am desperately trying to get out of bedside nursing. I’m sick of seeing people die.

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  3. Kenneth Skotnicki

    Please do not say G damit, why not Budda dammit or Krisna dammit.

    Reply
  4. Kirsten Wiegert

    It’s unfortunate that someone is going to edit this and the trash that will be published on social media is going to be negative. Sadly, many of my colleagues will take the easy road and not spend the time and sit through all 22:37 of your commentary. I did, appreciated the candor, and welcome the discourse.
    Doctoral degree or not I repeatedly correct the patients who call me Doctor because to them I know they identify this moniker with the role of physician. I recognize the differences between our two professions. When well meaning people ask me if I am going to go to medical school I gently educate them that this would be a career shift for me and the two roles are not interchangeable.
    That said, I agree medicine should be collaborative but take pause with the concept of supervision. This is not because I am beneath supervision but recall colleagues (physicians are not exempt) who use this model to their advantage – an excuse not to achieve the pinnacle of one’s education and licensure. The general consensus with this belief is there is someone who will serve as “backup” and it is not necessary to have the knowledge (we all know that person who tests well but can’t perform).
    I work with physician who has agreed to mentor me and we collaborate daily – even though either is not mandated by the state. I have a panel of internal medicine patients for who I am responsible; the majority of these patients have never seen my physician mentor. I know my limitations and he is aware of these as well. He is confident I will come to him if I need him. It is because of this our relationship works.
    This is 3.0 to me. I think it is time for all of this to be over and for us in medicine to act like adults and deliver the care the nation is deficient in.

    Reply
    • Rachel Clements

      Well said, and I agree. I ask my patients to just call me Rachel, that I am not a doctor.

      Reply
  5. Rachel Clements

    I work regularly with physicians like Primary Care, Pediatric, Internal Medicine, and other specialties in my community. I am the go-to for mental health care outside of the inpatient setting. This is by virtue of being the only certified psych NP within a twenty mile radius! The highest compliment I have gotten from a physician is that I am thorough and provide good data from my work ups that they can use. This is something I learned from observing them as a staff nurse, and hope to perfect as a nurse practitioner.

    Reply
  6. April Going

    I have never wanted to be a physician . I have always been a proud ICU register nurse who is damn good at her job. With that being said I agree there are always a few bad apples in the bunch on both sides. As a soon to be nurse practitioner I can tell u I have never wanted to be a physician . I have always wanted to be a nurse and I still do . ..I agree with what u said even though the delivery was a bit harsh…I didn’t like the big FUCK U . I know my scope of practice but we nurses rise up to support our profession from evil . But I would like to point out that nurses have been fighting for respect and professionalismfor a long time , we hold are own with or without physician support . WE are the very backbone of the healthcare industry and we want to to work in a collaborative manner . We put up with enough shit from hospital administrators who will work nurses till their back break because there more concerned about their budget than actually providing quality care .We will not be silenced in our efforts to provide quality care for our patients we have worked hard to get were we are and there is a great need for us … No we are not medical doctors we hold doctorates in nursing practice and we do make a difference . We are proud ! We are members of the health care team not subordinates to anyone .That is what we want recognized and appreciated not placated . This division is real and i have never had issues with any paramedic just asshole doctors on a power trip.

    Reply
  7. username_1

    I feel people are confusing intelligence with depth of training. I also feel that someone should speak out about the incredibly dangerous mentality of the newest nurse practitioners. I saw a certificate being handed out to NPs congratulating them on knowing more than neonatalology fellows. Let us make things very clear. Right now, anyone with a bachelor degree – be it Russian literature or Mongolian ice fishing – can go online and in two years, have an NP degree. A neonatology fellow, has 4 years of medical school, three years of residency, and another 3 years of fellowship. So let the public decide whether an NP knows more than a neonatology fellow. The public can also decide whether the concern by doctors that people with far less training are seeking to be perceived as exactly the same as doctors is just ‘ego talking’.

    Reply
    • Jake Johns

      I think you are misunderstanding the difference between an np and a pa. Joe Schmo of the street with an underwater basket weaving bachelors cannot enter nurse practitioner School but they could go to pa school. My school requires one to be an rn with two years experience and then enter nurse practitioner School. So at minimum a np from my school would have 6-8 years total in practice. I am not saying an np is the same as an md/do but I am also not saying that np’s have little training like you said.

      Reply
    • Meredith Stewart Ashley

      You have no idea what you are talking about. You cannot go to NP school without being an RN first. PAs can have a bachelors degree in other areas and yet, their PA training is rigorous and produces excellent providers. Try to be more informed when you post so passionately about a field you so clearly know nothing about.

      Reply
  8. Nora Brennan Berry

    The one take-away that I received from this situation, the same that I had to experience during a code last week, is that no matter your IQ or your experience it is your ego that can make you a terrible and unsafe provider. When you choose secondary tasks over primary tasks on a ROSC patient because you believe that what you are doing is more important than what the ED tech is doing or when you task your very experienced ED nurses to hold items for you during a code (treating them as nothing other than an extra set of hands) then you are no longer helping your patient. The ego is what divides, not the degree or the title (or the experience for that matter because a critical care or ER nurse of 5 years trumps a new resident physician in experience most often). And you cannot tell me that is false because I had a resident ask if a nurse could watch her do sutures, to make sure she was doing them right, just last week. I love the majority of our ER docs, they are amazing and respectful of anyone who does not act like a total moron. But the docs like this pain management doc are picking a fight that only hurts the patient because of it is so divisive.

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  9. Brandi Renee Gutierrez

    NP in training! THANKS ZDOGG for this! I 100% agree with recognizing scope of practice and training/experience levels. I actually feel there should be some practice requirement for NPs to enter the program. I have 15 years nursing experience and still feel that I will need the collaboration and oversight to do my job well. I can’t imagine having minimal experience and being able to practice independently. It is a 2 way division we face and we all must work to close the gap! At Least we must be open minded and KIND!!!! Much love!

    Reply
    • CMGraham

      I was floored when one of my RN friends told me that a girl in her NP program has been an RN for less than 6 months, has never worked a day on the floor, and has no prior experience (like EMT or Paramedic) prior to going to RN school. In EMS we have a term for this – “Zero to Hero.”

      Reply
      • Jake Johns

        I was under the impression that all np schools had a practice requirement. I am an np student at a school that is not top rated and they require at least 2 years experience related to the np field you are studying. I thought this was common practice.

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  10. CMGraham

    As a Critical Care Paramedic, I loved this cast. My PCP is a DO, but usually, I see the NP in his practice, because, usually, I’m going to his practice because I need a refill prescription, I need labs ordered, a test ordered, or I need a prescription for a med I can’t get over the counter. Most of this the NP can do for me, and now that she has gotten to know me, she knows that, when I ask for something it’s usually because I know that I need the prescription for something and I’ve done what I can to take care of my illness beforehand. Occasionally, she’ll go to one of the doctors’ offices and ask them to come in and talk to me, about something higher leveled, or because I have a very specific question that needs to be answered. I think this is appropriate, and good practice for my medical care, because 90% of my medical care can be performed by her.

    I loved that you commented on Nurses and Physicians shitting on Paramedics, because we do get shit on – A LOT. People like to think that paramedics are below RN/BSNs, but what most folks don’t realize, is that many of us have bachelor’s’ degrees in biology/ physiology/ hard science based degree programs (says the medic with multiple degrees and one in MLT.) In my state, there is a lot that a paramedic can do that an RN cannot do, but the only thing an RN/ BSN can do that a paramedic cannot do is actually hang blood products. I have had opportunities to go to nursing school, and I passed the MCAT and was accepted into MD school and PA school, but I’ve learned I just don’t like people that much, that I can’t be caring for them one on one for 6-12 hours per day, like an RN/BSN, I could do PA, but have family commitments for the next several years, and with all the restrictions and crap that the federal government is placing on MD/ DOs I wouldn’t be able to actually spend the time treating patients – which is what I would want to do.

    I couldn’t agree more that we need a more collaborative system, where each group (including the Nursing Associations and Unions) admit they screwed themselves over about 20 years ago when they moved to limit paramedics’ scope of practice in the ER, but now, ( at least in our area) they need highly trained fellow professionals that can also chart, administer meds, follow protocols and draw labs, bring concerns to the physicians’ attention, and so on. Paramedics have their own specialty and their own roles to play outside the hospital and, with the onset of the community paramedic program, and the evidence of the roles that paramedics have played in remote medicine programs, we need to be brought into the fold as fellow medical professionals.

    Reply
  11. Brett

    I totally agree with everything you had to say. I did not go to medical school after deciding I did not want to be on call all the time and go through all the training with garbage pay that physicians have to do. I became an Acute Care NP instead. I have covered 32 ICU beds by myself for 12 hour nights (obviously, with my attendings on call). I did all new Critical Care consults, intubations, arterial lines, and central lines. I practiced, as you said, at the top of my license and training. I did not, and could not, have come out of NP school straight into doing that. It would habe been dangerous and irresponsible. NP training does not prepare us for that kind of thing. I basically made my own residency by doing Internal Medicine for 2 years on Medicare and Medicaid patients with extensive chronic comorbidities and high medicagion utilization before I dared step foot in Critical Care as a provider. That was even though I was a bedside ICU RN for 4 years. Being an RN simply does not hold a candle to being the provider. All respect in the world to those that stay at the bedside, but it is just a fact. Another fact is that NPs should NEVER work in a specialty without physician collaboration. I do think NPs with about 3 years of full time experience AFTER graduation from NP school who work in Primary Care should be released to indepent practice. NOT ONE NP EVER should practice independently straight out of school, even if they libe in states that allow it. We all need to swallow our damn egos, practice to the best of our abilities, and let the best person handle the job. I worked in a great place at one time where Internal Med docs would call the Critical Care NP/PA in house overnight to stabilize their crashing patients. It was not because they were incompetent. We just simply did that every night, so they deferred to us. If or when I was in over my head, I always had the option to call my own attending, who knows by far and away more about medicine than I do. Mad props to physicians. Respect the hell out of you guys/gals. I just want to work where we all reapect each other and defer to the most competent in any situation. Sadly, that has been difficult to find. – Brett Whaley, MSN, RN, ACNP-BC

    Reply
  12. Karen Sloane

    A couple of different points… I think that a lot of the rifts that you’re speaking about are very department/culture dependent. I’ve been a nurse for 20 years, the last 8 years in the ED and I’ve worked in many ERs. I’ve noticed that the dynamics you speak of, Dr. vs Nurse, Nurses vs Paramedics, even ER vs floor nurses, etc, depend DRAMATICALLY on the culture of the particular department. I’ve worked in some excessively toxic departments before where everybody was at each others throats and it was pure misery. I currently work in a department that is amazingly cohesive and totally team oriented, where everyone down to Environmental Services is recognized for their contribution to the whole. It SPECIFICALLY because we have an amazing manager and a hospital that takes it’s “community hospital” designation seriously. Same with the paramedics… We love our medics and they love us. But I’ve been in the throes of the negative approach you describe, and it’s just awful. A key to achieving that success, IMO, is that a given group has to overtly acknowledge the value of each of it’s players roles and must insist that that approach be adhered to. It makes a world of difference.

    Reply
  13. Angie Powers

    I hate all of the attention that this doctor has received with his NP minion, low IQ, god complex rant has created. Sick of it!
    Two points I want to make 1). There are many doctoral degrees. Do you not recognize their accomplishments and respect by addressing them as ‘doctor’?
    2). Do doctors not collaborate with with other doctors/ providers? For the sake of patient care- to consult on a specific issue? Yes…..NP’s collaborate as well. Good doctors and NP’s do.
    Yes- I am a doctoral educated NP and proud of it. Love that I am part of the health care team. More 3.0 please…….

    Reply
  14. CarolEme

    I happen to agree with you. I am a Psychiatric Nurse Practitioner with a great collaborating physician. I am thankful that I have him for a resource. He meets with me 1X a month and discusses whatever I want – a specific patient, questions about practice, etc. What he has no interest in (has said this in the exact words) is to review my charts, beginning benzos, etc. Why? After working with him for 5 years, he trusts me. Period. He respects me and supports me. This being said, the majority of NPs I know – across several states, report that their ‘collaborating physician’ signs the agreement for collaboration, takes a fee (upwards of several thousand)…then disappears for a year to repeat. We ALL need to step up and work together. And, BTW – there is NOTHING worse than ANYONE who calls themselves ‘doctor’ in a healthcare setting who isn’t a physician. This includes PharmD’s (I’ve seen it), DNP’s, etc.

    Reply
  15. Tasha Berry

    As a nurse in Canada who works on a busy acute medical floor I just wish everyone in healthcare would be allowed to work to the top of their scope, and support one another. Oh, what a world that would be.

    Reply
  16. Linda Jorgenson

    The 11th commandment – Thou shall not be an asshole.

    Reply
    • Kenneth Skotnicki

      I like this, infers responsibility for the first ten . I asked Zdog MD “Please do not say G Dammit” But I don’t care if he uses Budda dammit, or Krishna Dammit.

      Reply
  17. Alouette

    I almost died of blood clots in my brain, bleeding ulcers, and acute kidney failure because a nurse practitioner sent me home without anything other than a broad spectrum antibiotic and instructions to come back in a month. A month? I knew I couldn’t last days, so I was taken to the ER where these things were diagnosed. If I had been a good little non-questioning patient, I would have just stayed home and died. But no, I had to question whether this nurse knew anything at all about what I had going on, and I had the presence of mind to seed emergency care. But what really gets me is when nurse practitioners and LPA’s are misrepresented by the staff as being physicians. On so many occasions I’ve been escorted into the examing room and told, “The doctor will be in to see you shortly.” Doctor? What doctor? There wasn’t a doctor withing miles. Being misrepresented to patients as a doctor, and then seeing trusting patients, is against the law, it is a crime to impersonate a doctor either overtly or tacitly, and it is unethical. But to the unsuspecting and trusting patient who is told the nurse is a doctor, that person will believe he or she is actually being seen by a doctor. And that is horrible to fool trusting people in that way, just so doctors can clone themselves and be in several exam rooms at once. And does anyone actually believe that the doctors are so out of touch with their staffs as to not know that their nurses are being misrepresented, perhaps not by themselves, but by staff who also know they are not doctors? I can see an end fo the np and lpa things on the horizon when the medical malpractice lawsuits start piling up, for the doctors are exposing themselves to a huge liablity risk by shirking their duty and handing over very sick people who are injurd or who die at the hands of np’s and lpa’s. But then, the last thing any doctor wants is an informed patient.

    Reply
  18. Ervin Williams

    Yes call me doctor if I have my DNP. I am not saying call me physician.

    Reply

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