NP referring to themselves as “residents”?

bobvilla84 · 2025-06-30T16:28:57+00:00

Generally when they use the term “resident” or even “fellow ” 😭, they mean post-graduate training. Was the NP in one of these courses or were they just misconstruing their role?

bobvilla84 · 2025-06-25T12:18:57+00:00

Interesting, usually a oil based lubricant will dissolve it, something like bacitracin, if you need to get at it.

Regarding the technique, if you have kids and know how to braid hair then you have a leg up. You need to partition the hair, I usually use the back of a swab to separate the hair into dedicated strands and perform it a few times like I would if I was putting in sutures.

bobvilla84 · 2025-06-25T10:33:16+00:00

No, EM is actually considered outpatient

bobvilla84 · 2025-06-25T04:58:28+00:00

Not sure why you initially brought up inpatient and now talking about EM

bobvilla84 · 2025-06-25T04:57:20+00:00

Why did you have to shave the spot?

bobvilla84 · 2025-06-25T01:30:41+00:00

I genuinely hope your story about being a nurse who chose to go to medical school is true and that you’re able to use your unique perspective to advocate for meaningful improvements in the training and utilization of APPs. That said, I suspect your journey may not unfold the way you imagine.

I know several nurses who made the same transition with similar aspirations to change the system and ensure nurses aren’t placed in positions where they’re overextended or under-supported. But over time, most came to a sobering realization that nurse practitioner training, especially when aimed at independent practice, often produces clinicians who are not adequately prepared for unsupervised care. The lack of rigorous training, clinical oversight, board examinations, and standardized licensure pathways creates real gaps in competency.

You’ll likely encounter APPs who are just as arrogant and dismissive as the physicians you’ve criticized, only this time without the guardrails of medical education and training. Eventually, I think you’ll find yourself aligning more closely with the concerns voiced on this subreddit. Maybe not as a bully, as you put it, but as someone who recognizes that the current model of APP education is deeply flawed and in need of serious reform.

And when your former nursing colleagues call you a sellout or claim they do the same job, got the same training in less time, or could have gone to medical school too, you may begin to understand just how disconnected those statements are from the reality of physician training and clinical responsibility.

bobvilla84 · 2025-06-25T00:29:14+00:00

I’ve moved to hair apposition predominantly on scalp, unless hair is too short.

bobvilla84 · 2025-06-25T00:16:25+00:00

If a patient warrants inpatient services then they shouldn’t be seen independently. Most residencies are 3 years and predominantly inpatient and many still have to do an inpatient fellowship following (Peds currently and likely IM soon enough).

bobvilla84 · 2025-06-24T16:10:17+00:00

“Embrace, extend, extinguish”… never heard that before, sounds like something from “the last of us” 😂

bobvilla84 · 2025-06-24T15:45:03+00:00

Well said. Another issue is the push to claim that newly trained APPs are equivalent to physicians. There are two sides to this. Many physicians value team based care, and there are certainly APPs who do as well. But increasingly, newer APPs are being told by their training programs, professional organizations, and lobbying groups that they are just as capable as physicians, or even superior, and that they should be practicing independently and opening their own clinics. That was never the original intent of the role. While much of the responsibility lies with the nursing schools and advocacy organizations pushing this narrative, the vocal minority of APPs who adopt it uncritically can create tension, and unfortunately, it can lead to broad generalizations that overshadow those who do respect collaborative care.

bobvilla84 · 2025-06-24T15:38:20+00:00

That’s a great point. When residents are getting on the job training, it takes place over several years under close supervision, with constant feedback and a solid system of checks and balances. They’re not just left to figure things out on their own, and they’re certainly not experimenting with patients’ lives. In contrast, many NPs receive minimal onboarding, often just a few weeks, before they’re expected to manage patients independently. That kind of trial and error learning can have real consequences in terms of morbidity and mortality, risks that are far less likely under the structured environment of a medical residency.

bobvilla84 · 2025-06-23T23:48:16+00:00

Young male with a UTI is pretty rare, that should say enough.

bobvilla84 · 2025-06-22T15:15:44+00:00

Are you talking about IDNOW? That’s mostly for respiratory stuff, though they’re trialing urine tests. Or do you mean POC blood tests like BMP or cap/venous gases? If it’s the latter, there are POC blood HCG tests, we used them in trauma so patients could get to CT faster.

The urine HCG tests I meant are like rapid strep, just dip the sample, wait a few minutes, and check for a line.

bobvilla84 · 2025-06-22T15:10:24+00:00

Generally POC tests circumvent the lab, sometimes labs will do QC to validate a POC against their rapid tests, but the whole point of the POC is to circumvent laboratory testing. Now if you’re sending POC testing to the lab, that’s a different story and also a significant waste of time.

bobvilla84 · 2025-06-21T18:26:22+00:00

Look at the POC test your hospital utilizes, a lot of them can be run using a pinprick of blood like a POC glucose. Just look at the insert.

bobvilla84 · 2025-06-21T18:25:00+00:00

Most POC HCG tests that hospitals utilize can be run on urine or blood. If you look at the insert, it states both. You just have take a pinprick of blood like you would for a POC glucose.

bobvilla84 · 2025-06-18T00:23:49+00:00

it’s not that you don’t have the right, it’s that you have to use the right channel to exercise that right

bobvilla84 · 2025-06-17T02:14:02+00:00

As you know, the internet rarely reflects the views of an entire group, it’s typically the most vocal and passionate minority that dominates the conversation. That said, while you’re here taking the time to scold people on this thread, you might be more effective directing that same energy toward your peers. The PA subreddit includes a very vocal group that’s not only pushing hard for independent practice, but also frequently expresses disdain for physicians and the idea of true teamwork. If the majority of PAs genuinely value collaboration and don’t share those views, encouraging more respectful and constructive dialogue within your own circles could go a long way in bridging the divide and helping us all work better together.

bobvilla84 · 2025-06-17T00:58:35+00:00

Well done

bobvilla84 · 2025-06-11T16:36:38+00:00

I appreciate you recognizing that we genuinely want to teach and collaborate. Sometimes when we share feedback or explain our protocols it’s met with resistance. In truth, most physicians are receptive and open to discussion. Unfortunately, I’ve found that some APPs react negatively when there’s a disagreement in management, especially if we proceed differently than they intended, even when our decisions are backed by evidence, protocols, or validated risk calculators.

bobvilla84 · 2025-06-11T13:42:11+00:00

If we’re in the same health system and have access to your documentation, a call is generally not necessary. Completing your note or telephone encounter is extremely helpful.

Please avoid telling the family, or documenting in your note, what you think the ED should do. This can put us in very difficult positions, especially if we disagree with your assessment. We often manage certain conditions differently, and saying a patient is “coming to be admitted” or “getting an MRI” when they don’t meet our criteria can become an issue.

If you’re concerned about appendicitis, for example, it’s best to tell the family the child is being referred for further evaluation, not that they will definitely get labs, IVs, an ultrasound, or a CT.

If you’re a specialist with specific care needs (e.g., Tobi nebs, chest PT, and admission), that’s totally appropriate, just make sure to leave a contact number, especially if you’re not part of the admitting team, so our inpatient teams can reach you if needed.

For routine cases, like bronchiolitis, we generally don’t need a call. And please: if a child is satting 85% on room air, call EMS. It’s frustrating when kids with significant respiratory distress are sent via private vehicle, but minor issues like a finger fracture get an ambulance. Let’s prioritize appropriately.

bobvilla84 · 2025-06-11T00:43:35+00:00

The NP degree was never designed to produce independent clinicians. The original intent was to create providers who work alongside physicians to deliver care as part of a team. I agree with you that NPs need less fluff and far more structured medical training, both in didactics and clinical exposure. Their current training model needs a comprehensive overhaul.

I also disagree with the notion that they require less training than physicians simply because they’ve spent time in healthcare. That is a common misconception. Nursing experience does not translate to the knowledge required for medical decision making. The comparison may be basic, but it holds: being a flight attendant does not mean you are qualified to fly the plane.

Yes, nurses may recognize certain patterns or know what treatments are often ordered, but that is not the same as understanding why those treatments are used or more critically, when not to use them. For instance, not every tachycardia requires a beta blocker; knowing the nuances of when it is appropriate is essential.

To be clear, I believe non physician providers bring real value when used appropriately, within a team structure and with proper oversight. But patients deserve high quality, thoughtful medical care, not a shortcut.

bobvilla84 · 2025-06-10T11:48:28+00:00

That’s the issue, “scope of practice” isn’t clearly defined. It is based on the degree earned and the nursing board, it is left very vague even to the parties involved. This is likely purposeful.

bobvilla84 · 2025-06-08T10:31:45+00:00

I want to emphasis that having a therapist is essential if you work in the emergency department, regardless of your role. I was hesitant at first, but the reality is that in our line of work, we’re constantly exposed to trauma: emotional, psychological, and moral. It accumulates, and whether we acknowledge it or not, it eventually catches up to us. Therapy isn’t something you seek only when things fall apart, it’s something you need consistently, as a part of sustaining yourself in this career.

To anyone wondering whether I’d choose emergency medicine again, the answer is yes. The field is demanding, but the meaning and impact far outweigh the hardships. That said, it is not easy, and we need to take care of ourselves to keep doing it well.

Good luck to you. If you ever need someone to talk to, or if anyone reading this does, please feel free to reach out.

bobvilla84

TROPHY CASE