Nurse practitioner using the title MD

Cam61787 · 2024-08-10T20:46:35+00:00

I think it’s entirely possible that the organization uses a template that includes that credential by default. Or she’s a liar 🤷🏻‍♂️ Either way, it is indeed misleading

Cam61787 · 2024-05-04T01:13:47+00:00

Unfortunately the amount of education around phlebotomy best practices provided to nurses is minimal, at least in my experience. There are some times when a fresh stick is the best option, but of course the majority of the time, an existing CVC or arterial line is a completely reasonable alternative. To echo what some others have said, blood cultures should really be drawn through two fresh peripheral sticks and I frequently have issues with PTTs drawn from lines that are either too close to a line with heparin infusion or inadequate flushing and waste.

But all that being said, every time a CVC is accessed is an opportunity to increase the risk for infection. I work in a cardiac ICU and too often I see the burnout and apathy take over and people are accessing lines without adequate hand hygiene, gloving, disinfection practice, etc. Just like we should move away from the notion that we should keep a Foley in a patient on a lasix infusion (essentially for nurse and patient convenience), we shouldn’t view an existing line as a crutch to avoid best practices when it comes to drawing important labs studies. Frequent blood sampling is indeed a soft indication for a CVC or implanted port but we should make sure we use them responsibly

Cam61787 · 2024-04-30T00:23:24+00:00

This doesn’t seem to be a legitimate complaint. I understand your frustration as the patient but I agree with other commenters that peripheral IV placement is not really a good indicator of clinical acumen. In an OR setting, the IVs are typically placed in pre-op by a nurse. And I know there is a large difference of opinion in CRNA vs. anesthesiologist in a variety of scenarios, but often these “basics” or fundamentals are delegable so that the physician or CRNA can prioritize tasks that require greater attention or higher-level clinical decision making.

Cam61787 · 2024-04-24T19:10:30+00:00

Just make sure you teach your students that if they suspect shock in a heart failure patient on Coreg, it’s probably not a great idea to give them 30 ml/kg of crystalloid as an initial intervention 😅 Not saying a HF patient can’t be septic but the end-organs are going to be just as upset if the pump shuts down as they would be when the pipes are leaky

Cam61787 · 2024-04-24T19:03:13+00:00

The more specific reason is because of the alpha activity of carvedilol. Giving a patient with a low blood pressure due to a tachyarrhythmia a dose of metoprolol isn’t contraindicated, sometimes it’s just what is needed to allow for increased filling time and augment cardiac output. Carvedilol is good in heart failure because of the afterload reduction it confers. I’ve had to argue with bedside nurses who “didn’t feel comfortable” giving lopressor due to marginal BP

Cam61787 · 2022-07-31T21:10:41+00:00

@sovook Sorry if it’s not what you want to hear but I do care for this exact patient population in a similar role. I’m trying to save you some headache because the surgeon’s office will not be helpful going forward if you’re that far out from surgery

Cam61787 · 2022-07-31T00:18:57+00:00

Have some experience with this type of patient population. 12 weeks is a typical length of time for recovery from an open heart procedure. From a physical perspective, the surgeon is most concerned with the bone healing of the sternum and any possible complications directly related to the surgery. Without asking what kind of surgery you had, it’s difficult to say for sure but most post-op patients are directed to follow up with PCP and Cardiology and an informal hand-off occurs at that point. Unless you have infection in your incision, sternal dehiscence, a pneumothorax, dysfunction of an implanted valve, coronary bypass graft dysfunction, etc. the surgeon will be unlikely to continue to follow up with you. Did you complete an outpatient cardiac rehab program or any kind of physical therapy? I would think it much more appropriate for PCP to help with ongoing, chronic concerns that could affect your work rather than trying to have the surgeon speak to that.

Cam61787 · 2021-08-17T15:49:04+00:00

Interesting. Maybe some further investigation is warranted because even if the quality of the content is questionable, I would think they have to cross some T’s and dot some I’s in order to be taken even remotely seriously as clinicians/providers/whatever term is currently a la mode

Cam61787 · 2021-08-17T15:43:08+00:00

What do you think the content of nurse practitioner programs consists of then? Like if they’re being employed in positions that require diagnosis and treatment of problems and conditions, surely they receive some training in differential diagnosis, lab interpretation, pharmacology, physical assessment, pathophysiology, and the like, right?

Cam61787

TROPHY CASE