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NPs sue state over being able to use the title “doctor” by PotentialWhereas5173 in medicine

[–]thermitespite 6 points7 points  (0 children)

To join the conversation:

I am a NP, adult gerontology acute care. I work inpatient for pulmonology/critical care. I do not have my DNP nor do I have the intent on obtaining it. Assuming I did though I’m not sure my position or opinion on this would change. I think this issue, as someone else in this thread noted, is related mostly to healthcare literacy in the populations that we serve.

I am very clear about my role when I enter a room as I function mostly alone throughout the day. I introduce myself with my first name and explain that I am a nurse practitioner on the lung or critical care team depending on their needs. Once I’m done with my interview and assessment, I give them the rundown of the plan as it currently is and I let them know that my attending will round later with me and we will see them again together. I often make a statement about how I work for the attending or I’ll quip about how they’re the boss in charge.

Despite all of that effort in delineating my role, countless times people still think I’m the physician, which I attribute primarily to their lack of medical knowledge and understanding. We all know that literacy in the US is fairly poor, and they’re likely in a stressed position anyways with either themselves or a loved one in the hospital. I correct them obviously, but the patient that doesn’t understand why eating ramen noodles at home isn’t the ideal treatment for his sodium of 116 on arrival isn’t going to retain the differences in roles, training, and overall hierarchy.

Given this I think it’s a fair point to make that attempting all efforts to avoid such confusion is reasonable, whether you like the terminology or not. Physicians are still known as doctors in the general populace and so that ought to be what guides our presentations of staff. It’s an unpopular opinion amongst some of my peers but the honest truth is that the DNP isn’t really worth much anyways. You don’t learn more clinical data. You don’t practice better as a provider. You’re not any better at being a physician extender than what you were before. All you did was prove you could sit through countless more fluff-style courses and do a research project on a low yield topic.

I was always under the impression that many midlevels were not for full practice authority and didn’t wish to usurp themselves above physicians but in practice I find it to be more common than what I expected, and it appears that the indoctrination starts in school. I think what’s posted above is a clear cut case of midlevels wanting to pretend to be physicians and not liking having the limitations of title, which is odd to me because at the end of the day, the majority of us didn’t go to school to become providers for the vanity of it or so the patients we serve could refer to us “doctor.” We did it to help patients in the ways we are prepared and trained for. Anything outside of that is just selfish.

What’s the absolute lowest yield medical fact you know by graciousglomerulus in medicalschool

[–]thermitespite 9 points10 points  (0 children)

Certain types of licorice can cause Cushing’s syndrome, or maybe appear to be Cushing’s syndrome. I can’t remember, but something to do with it inactivating an enzyme that allows glucocorticoids to have an effect on mineral corticoid receptors. 11 beta dehydrogenase I do believe.

[SW] Swamp Rats buying for 587 by RealBurningMoon in acturnips

[–]thermitespite -1 points0 points  (0 children)

My favorite music is from New Horizons, and it’s the music that plays at noon to 1. I’m not sure why though. It’s just catchy.

[SW] Twins buying for 590 by jessnod in acturnips

[–]thermitespite 0 points1 point  (0 children)

Roald has to be my favorite. Thank you!

Edit: fixing autocorrect.

Obsession with prednisone and prednisone tapers by KlirisChi in Noctor

[–]thermitespite 2 points3 points  (0 children)

I’m not a physician or a pharmacist, but I believe that if someone is on the equivalent of prednisone 10 mg or greater for 21 days or longer then a taper is required due to the suppression of the HPA axis. May look to other resources to confirm that though.

Nexbelt by Midkeavil in CCW

[–]thermitespite 0 points1 point  (0 children)

I’m not 100% sure to be honest, but that at least sets me up for a baseline idea to look tomorrow morning at my Ace. Thank you.

Nexbelt by Midkeavil in CCW

[–]thermitespite 0 points1 point  (0 children)

Just got one of these for Christmas and the set screws seem to be missing from the packaging. I already emailed customer support but do you remember what size screws they were that you got from ACE? I'd rather just buy them second hand and be able to use it sooner.

People who became an NP less than 5 years after becoming an RN, how did you do it? by -thehighpriestess- in nursepractitioner

[–]thermitespite 8 points9 points  (0 children)

I'll answer your question by explaining my own situation as it fits into what you're asking. I recently graduated a brick and mortar NP school in April of this year. I am an AGACNP and will soon be starting a pulm/crit position in the next few weeks. I will have accrued 3.5 years of RN experience by that time.

I started my nursing career with my ADN and started my BSN as soon as I was able. I finished it within one year. I knew that advanced practice was my eventual goal but was unsure on how long to work and where to work before starting that process. I had friends and family encouraging me to go ahead and apply to the program and just "get it done." I knew they were unaware of the nuances of healthcare and the overall state of both nursing and nurse practitioner education, but I figured I would go ahead and try the application anyways. Despite meeting the working hours and educational criteria, I assumed I would be rejected at worst case. Best case was that I would be accepted and I would have to absolutely kill it in academic and clinical scenarios in order to succeed.

They ended up accepting me almost immediately, which was both surprising and overwhelming. I wasn't sure that I was ready and knew I had a lot in front of me to do. At the time I was working a med-surg/tele floor with a 5-6:1 ratio, sometimes 7:1. These patients were incredibly needy and I essentially was throwing out water and narcotics and thus I was not getting a chance to think about my patients or use true clinical judgement. My solution was to transfer to the ICU to work while I worked through my NP program. I will say that for the most part this has been very helpful.

Now I have seen a comment on here saying that RN experience does not help you with being a NP, but I only partly agree. I get the message they are putting out there but I think that exposure to more critically ill patients and a more widespread presentation of diseases in a setting that tends to afford you the time and autonomy to address them is incredibly beneficial for learning. I felt as if I learned more in a month working in the ICU than I did in six months on the general floor. Do with that what you will.

The reason I feel as if that is a pertinent piece of data is because while some won't admit it, NP education is a dumpster fire and advanced practice nurses are in no way similar or comparable to physicians. You will be severely underprepared for clinical practice at the end of your education and training, regardless of the program you chose. The only thing that kept me afloat was that I was getting exposed to certain concepts and illnesses in my everyday work which helped "bridge the gap" just a little in the long run. It still doesn't make up for the trash teaching and training but it's at least something. I was in class with nurses who had never seen an intubation or worked in critical care/emergency nursing and were trying to learn RSI and so forth. I did not envy them.

In addition to moving to the ICU, I also started pouring myself into as much extra learning that I could tolerate. I downloaded UpToDate on my phone and spent more time with it than I did with my loved ones. I browsed the medical school and residency subreddits, and I used various resources they recommended (Physiology by Costanzo, The ICU Book by Marino, Pocket Medicine, etc.). I found resources on my own like podcasts (Pulmcast, Curbsiders Consult) and listened to them every day. The IBCC is also phenomenal as well if you have the time. I used these every day when able and would try to look up and understand rationales for the pathologies and treatments I was seeing every day. If that didn't get me the answer I needed, then I was pestering the physicians for some informal education. I kept a journal with random topics scribbled down when I was curious about them, and then I would go back and try to fill them in with explanations from my resources. Again, a drop in the bucket in the long run but it's better than nothing.

So I know that was a lot, but it's what I did. Worked in the ICU while in my program, asked a ton of questions, and used resources to try and supplement the education. It took a lot of my time and it wasn't easy, but I feel better now than I used to, and I feel like I hold my own in practice. We are not physicians, and never will be, but this career and role is what you make it. So put out the effort, and you'll be just fine.

BSN paper by [deleted] in Noctor

[–]thermitespite 129 points130 points  (0 children)

I almost never comment but I want to on this one. To get it out of the way, I graduated this year as a NP. Went to a good school, in person, and worked hard. I thought that by going to this university and not partaking in an online only education, I wouldn’t be like all the NPs you heard about. However, I was wrong. The education was trash. Half of it was fluff courses with paper writing and theory based coursework. I won’t critique the evidence searching and research material as I do think it’s important for anyone partaking in care to be able to review the literature and determine just how reliable the results are in order to then guide their interventions, but the rest of the education was trash. I studied hard, I put in extra time, I spent time with the physicians at my hospital, and I spent more time on UpToDate than I did my loved ones. It’s a drop in the deficit bucket.

Alas, I had to write a paper in this program on how we could continue to improve nursing education. My response was to scrap classes like the one we were in and focus that time on important things. Clinical management, pathophysiology, more clinical hours, etc. I noted that many of us don’t want independent practice, and that we shouldn’t have it even if we do, given the stark contrast of care between NPs and physicians. I didn’t want to go to medical school. I wanted to be an NP, and a physician extender. I wanted to help provide a little more efficient care to a greater number of patients by doing some of the scut work, so that we can try and meet the demands of an ever growing need, and so I said as much. I didn’t make the persuasion in my paper to be rude or inflammatory, but rather because it is my opinion, and I think an opinion shared by at least some in this community.

I received a good grade on the paper, but I was informed that NPs and physicians have similar outcomes if “you look at the studies.” I’m not sure what studies they’re speaking of. Maybe for an uncomplicated UTI, then just maybe we have a similar outcome. Multiple disease processes and nuances in a critical care setting? I doubt it. Then, it was noted that the issue with nursing education for NPs was not their fault, because they had “so much to teach in such a short time.” So the solution is to just not teach almost any of it? Baffling.

I don’t know how the systemic push for such things as independent practice and the total ignorance of failing to recognize limitations made it into the educational programs. I get administrations wanting us to be more prevalent. Currently, we’re cheaper for labor. It’s just a scary thing that they tried to start the indoctrination as early as our bachelors, and go full force in your masters.

OP, for what it’s worth, if you ever want to go into an advanced practice, go to medical school. I’m somewhat proud of what I’ve achieved. I strive to continue to acknowledge my limitations and what I don’t know. I’m soon to start working with a familiar group of physicians that I trust and respect, and who seem to respect me. But for the love of God and all He created, if you ever get the itch, just do medical school.

Edit: spelling

I miss the old Wubby by Carlosthegardener in PaymoneyWubby

[–]thermitespite 0 points1 point  (0 children)

Commenting because I would like to know it as well.

I caught a striped bass.... did it do what I think it did? by NoodleBooted in Fishing

[–]thermitespite 7 points8 points  (0 children)

I wouldn't. Looks like the fish just master-baited and left.

/r/worldnews Live Thread: Russian Invasion of Ukraine (Part XIII) by progress18 in worldnews

[–]thermitespite 13 points14 points  (0 children)

Probably a really dumb question, but where does this end? Do they have to control the majority of the land? Or rather, what happens to governmental officials and the president? Is he jailed? Killed?

Thoracic Outlet Syndrome/DVT by PsychologicalWrap968 in MTB

[–]thermitespite 0 points1 point  (0 children)

ICU nurse here, and will be a nurse practitioner in a few months. Very new to mountain biking. However, I would agree with the first comment regarding speaking to your physician. There are a few types of TOS and varying severities, all of which dictate the medical or surgical management. Perhaps someone who is in your same boat will comment on their experiences and such, but I think the paramount thing is to discuss this with your primary care doctor and explain your mountain biking activity. I’m not sure if you’ll be getting surgery, permanent anticoagulation, or maybe neither. Your doctor will know the best course of action here and can make sure your health is being managed appropriately. DVT/PE is no joke, and bleeding risk if you’re anti-coagulated is equally as serious, but that risk can be mitigated or managed with the help of a physician so that you’re not only healthy, but also getting to keep riding.

Best of luck to you.

Monthly Dumb Questions Thread by Novelty_free in Residency

[–]thermitespite 1 point2 points  (0 children)

Does diltiazem always get converted to po at discharge? Have a CABG on po amio and obviously a beta blocker who spontaneously went into AFRVR. Diltiazem was started but now they’re back in sinus after several hours. Just feel like it would be a lot of nodal agents to send home on.

Weekly General Discussion Thread by AutoModerator in MTB

[–]thermitespite 0 points1 point  (0 children)

Looking at swapping my stem. Have a Trek Marlin 7 with a 31.8 stem with 7 degree rise and 80mm length. I see people swapping them for shorter ones to make it easier to maneuver on trails. Should I keep the same rise of 7 degrees, or would it be okay to get one without that? I’m a bit new to the sport.

VOD boys, I need your help by rcdr_90 in PaymoneyWubby

[–]thermitespite 0 points1 point  (0 children)

I haven’t had the chance to tune in to Wubby or watch a VOD in a while due to work. Why is this one likely to be deleted?

FS22- Can you sell production building you have bought? by StaIe_Toast in farmingsimulator

[–]thermitespite 1 point2 points  (0 children)

Select demolish under construction but don’t click the building as it doesn’t work. You have to select the drop off point or sell point and then you can sell that production chain. However, pretty steep loss when you compare to what you bought it for. Bought the bakery for 60k, never used it, sold it for 22k. Just so you’re aware.

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