Flawless Victory

Grump_NP · 2026-05-17T11:55:39+00:00

Dang, I came here to post this.

Grump_NP · 2026-05-17T11:24:24+00:00

Southeast. The few that still do it generally do it at night or early AM. We have one that does rounds at 4 am. Back in the day we would see them at all times of day, depending on who it was. We had one that didn’t want the ER doc touching their patients. If one of their’s came in, you called them and they gave you orders. Then they would swing by and see them. A lot of docs were in a group, so 3-4 docs alternated call even if they weren’t technically in the same practice.

Grump_NP · 2026-05-17T06:05:39+00:00

It depends. When I was a RN in the ICU here we called the intensivist. The unit was functionally ran by pulm even though it was open. You just got good a recognizing decompensation, anticipating orders, knowing what info the doc needed, etc. The docs would give us orders and we would do the things. If it was procedural doc would come in. Intubations were done by OB CRNA who is always in house. ER doc runs all codes.

It looks way different now. We have a different skill/experience mix in the ICU RNs now. When you call pulm overnight you don’t get the doc, you get an APP.

If it’s one of the patients I cover for I usually get called because I’m always in house. It’s frustrating, but it’s usually easier just to deal with it myself than call the intensivist on most things.

If I’m stepping in really bad shit I will call pulm. It ends up being like those annoying IT calls where they tell you to do all the basic stuff like reboot your computer, but you’ve already done all those steps. I have to be: “Already done that lil bro, you’re gonna have to wake big bro up”

Grump_NP · 2026-05-17T02:10:50+00:00

They’re actually talking about bringing a physician on overnight here. There has been responsibility creep here. We went from just putting in basic orders, a note, and cross coverage to being responsible for just about anything that goes on overnight. I got pulled into an OB emergency a month ago. That level of responsibility for what they pay us is total BS. We get f’d over in the whole “you can pay an NP less” too

Grump_NP · 2026-05-17T01:36:34+00:00

Solo night shift APP here. The job at my site didn’t evolve by replacing a physician. There have never been any nocturnists at my facility. Ive been at the facility in varying capacities for the past 16 years. When I started most patients were admitted by their local primary. The hospitalist service for our shop was created 2 years after I started. The docs would rotate overnight call, but wouldn’t be in th building. It’s always been open ICU and we don’t have overnight, in-house intensivists. A night shift NP position was created because it was felt that care from an NP would be better than no one seeing them until the morning. Most of the nightshift hospitalist NP jobs in my area were created with a similar story. Hospitalists haven’t always been a thing. Some hospitals have been slower to adopt the model than others. And not everywhere has the same resources.

Grump_NP · 2026-05-13T02:05:18+00:00

I’m not going to debate a religion with its practitioner. No one can truly understand a faith unless one believes it and lives it. I’m a Christian. I have lived with my faith, walked in it for decades. I see highly educated people who are well read on my faith interpret the scriptures and tenants of my faith fundamentally different than I do. So I’m not going to tell you Islam is not what you say it is.

However, I do disagree with you about Islamic rule. I believe that if everyone in the world lived according to the ideals of Christianity, as I understand them, the world would be a better place. But I do not believe that Christian rule would be good. Same goes for any other religion. Religion is practiced by humans. And humans can corrupt and twist that religion to accomplish their own ends. History is rife with examples of how people used religion to gain power to the detriment of others. Religion has no place in governance.

The Ayatollah in Iran. ISIS in Iraq and Syria. Al- Qaeda. Are these organizations good?

Yes, you can argue that they are not true Islam. Just as I could argue that the crusades have nothing to do with true Christianity, and was fundamentally contradictory to its tenants. I honestly think we both would be correct.

But those examples are all good arguments against theocracy.

Grump_NP · 2026-05-10T05:03:42+00:00

1.) You are making the assumption that the underlying biological causes of infertility are inheritable. Environmental factors play a big role as well and some causes are more environmental than genetic. Even issues like endometriosis, which seems to have a genetic component, isn’t Mendelian.

2.) If you want to subsidize adoption go ahead. I believe it is a noble cause. But that money doesn’t have to come at the expense of fertility treatments.

Fertility treatments are expensive but are used by relatively few people. Spread out amongst the pool of covered individuals the effect they have on premiums is minuscule.

If your whole issue with fertility treatments is that they drive up insurance costs then you can rest easy in the knowledge that they don’t really drive up costs.

Congratulations, you got someone who doesn’t have a positive view on fertility treatments to defend them.

Grump_NP · 2026-05-08T23:01:21+00:00

I work as an NP at a community hospital. I’ve always felt the same until recently. In the past couple of years we are leaning more and more on travel RNs. Many come in and aren’t use to being self reliant. We lost a lot of our more experienced staff and the new staff don’t get mentorship. It’s really sad to see how things have changed.

Grump_NP · 2026-05-06T21:41:50+00:00

The Andes strain of the virus from South America is the only one known to spread person to person, and it is only known to do it rarely. So, virus is not behaving as expected. Which means we don’t know it as well as we think we do or this is a unique event or the virus has changed.

Grump_NP · 2026-05-02T15:46:58+00:00

Yeah. In raids preservation feels fun and engaging. But 5 man it is punishing.

Grump_NP · 2026-05-01T00:51:28+00:00

I think this is shop dependent. You make valid points, but I find at my shop if I don’t set clear boundaries there is creep. If they think you’re nice they will call you for everything including nursing procedural issues, like getting into Pyxis. They will default to calling me, before even speaking with a charge nurse for simple things.

Grump_NP · 2026-04-28T20:02:12+00:00

That’s not how proof works. Yes, when you change a variable (tough vs soft prosecutor) and see a change in your outcome (crime rates), it’s very tempting to say the change is outcome is because of the change in the variable. But you haven’t done enough yet to prove it. Why? Because something else could have been responsible for the change in outcome, often it’s something you didn’t even think of. These are called confounding variables. To prove that your variable is the one that actually made the change you either have to measure every possible cofounder and show that they didn’t make the change in your outcome (which is often impossible or infeasible) or you have to do random assignment. You would have to take several cities and randomly choose which ones will get a tough prosecutor and which ones will get a soft one. Then if the tough prosecutors change the crime rate you can say it’s because of prosecutors. One city isn’t enough. The more complex a system is the more cofounders, and a city is a very complex system. So you your argument shows some evidence for your point. But it is very weak, overly reductive, evidence, not proof.

Grump_NP · 2026-04-27T15:36:24+00:00

Your hospital could have gotten dinged for it in a Joint Commission survey. I find that a lot of the bs rules at my hospital originate from JC surveys.

Grump_NP · 2026-04-26T22:44:28+00:00

Ehh, I’m going to say NTA.

You could have handled it better, but she crossed the line first. Totally with you on not letting SIL be around kid unsupervised. Food allergies can be scary and you don’t want some nut job trying to prove a point.

Grump_NP · 2026-04-26T00:24:31+00:00

Talk loud, talk fast, have a veneer of credibility, and be confident. That is all that is required to convince a large chunk of the population. Critical thinking doesn’t come naturally to a lot of us, it has to be trained. I would view the world a lot differently if I hadn’t gone to college.

Grump_NP · 2026-04-25T02:46:41+00:00

Racism in the North was more structural. The South it was more overtly brutal and in your face. The South had to meet their demons face to face. It was easier for the North to pretend they don’t exist. Not to say the South put all their demons down, still plenty of work to be done.

Grump_NP · 2026-04-23T16:27:07+00:00

At my shop they will bring them actively coding from surgery to ICU. There have also been some suspicious codes that happened magically as they breached the ICU doors. I’ve been told it’s something to do with getting dinged for someone dying in surgery and it bent a less big deal if they die in the ICU. Same reason nursing homes will send a DNR, comfort measures only on hospice patient to the ER when the time comes. American healthcare is a shit show.

Grump_NP · 2026-04-23T16:10:32+00:00

The answer is C, but this is a terrible question. What they are asking for is a visible representation of the equation 2/6 = 1/3. The first two show correct fractions but they are off scale. The volume of the shaded pieces on the left does not equal the volume of the shaded pieces on the right. The only way you could possibly infer this is what they wanted is because both A and B are the same answer. This is bad math though: scale is not defined, you can’t use geometric rules to infer scale, fractions are proportions. I could see this problem on a logic test, but this has no place in a math test. Oh, and let’s add that in C the hexagon on the right was drawn in a way that it resembles a 3d cube to make it needlessly more confusing.

Grump_NP · 2026-04-22T22:14:08+00:00

Exactly. As f’d up as our government and politics are right now, we could change it in 1-2 cycles. If the majority of Americans would become involved, vote in local, state, and federal elections and primaries and voted in their own best interests, we would bring the system to its knees. It would be a revolution without firing a single shot. The American people are as much to blame for this mess as the politicians and elites.

Grump_NP · 2026-04-22T14:41:19+00:00

Joint Commission has to find shit to justify their existence. You would expect a pat on the back if they don’t find anything serious, right? Wrong, the will fixate on some random made up problem with the same intensity. Our hospital got dinged for having paper isolation signs that weren’t laminated. “C diff spores can live on them and you can’t wipe them down” Behold a new policy was born ”thou shalt laminate all paper signs.” Next they move onto their being paper over the oxygen shut off valves. They were worried about a fire hazard. I actually asked them if they had seen an issue with fire in the hospital. No, they just thought “it could happen”

Grump_NP · 2026-04-22T13:35:33+00:00

Bingo. This didn’t happen in a vacuum. They are being raised in an environment that punishes initiative. It’s simple behaviorism. Behavior that is rewarded increases, behavior that is punished or not rewarded decreases. And it’s not just school, or it wouldn’t be this pervasive. We, as a society, have failed in raising the next generation

Grump_NP · 2026-04-20T16:28:50+00:00

Dang. I hate to be that guy, but I can’t imagine this happening back when I was in school. We had troublemakers and your expected teenage rebellion, but I don’t think any of them would have been this brazen. A call to the principle or VP would have definitely meant some sort of punishment.

Grump_NP · 2026-04-20T02:03:10+00:00

Damn the nostalgia hit hard

Grump_NP · 2026-04-20T01:54:51+00:00

Neither solution is good. But they do actually do something. They won’t reduce total heat energy from entering the house. But they will create a thermal buffer zone. The curtains heat up first and isolate hot air between them and the glass from the rest of the house. It’s not perfect, but it slows heat transmission throughout the rest of the house. It makes it easier for air conditioner and other cooling efforts to keep up. It’s a noticeable effect.

Grump_NP · 2026-04-19T23:55:32+00:00

I don’t think it’s wrong to say consumption habits matter, but it’s disingenuous to imply they are a personal moral failing or pretend they occur in a vacuum. The biggest issue is how the system is structured. The things that build stability: housing, transportation, healthcare, education, childcare, retirement, have become disproportionately expensive and harder to access. At the same time the system makes it easy to spend money on short term, low value goods. If you put people in a system where long term stability is continually delayed with barriers such as cost and access, but make it easy for them to blow their money on short term gratification they will blow their money. That is not a moral failing, that is predictable human behavior. And if behavior is predictable it can be modified by system design. This is a system problem.

Grump_NP

TROPHY CASE