Wellness

[pitdakota]

@Nonametoday, LOL!  Yes, things have changed over the past 40 some odd years!  They didn't have bridge programs or 2nd degree programs back then either.  

[deedledeedeedle]

Where I work, a large hospital system, our Advanced Practice Practitioners or APPs (PA, NP, CNM {midwifes} etc) function in conjunction with the MD. They are credentialed, licensed by the state, speciality certified, and most "share services" with the physician, each contributing to the encounter. They round on most units including ICU, Trauma, Cardiology,Transplant Medicine, Internal Medicine, Peds, PMR (physical medicine/rehab) floor,  They staff the OP Observation unit (basically a doctor's office within the hospital). They perform surgeries and do procedures such as correct venous shunt malfunctions, casting, surgical assist, etc. They are extensively used at our non-teaching hospitals because they staff 24/7 while the private doc is on 8- 10 hour days. Each state determines to what extent the APP may practice their speciality. 

Personally speaking, 10 years or so ago I was referred to a surgeon by my internist for a vague one sided breast pain. Her NP performed the entire visit, answered my questions, ordered the radiology, and called me with the results. This person was an advanced practice RN with a dozen years experience in the surgery field. I never saw the MD and am fine with that. 

This is the way medicine has gone.  There are not enough physicians to treat the population as it stands, so these providers do a great service.

dee

[deedledeedeedle]

NOT TRUE. Do your homework. 

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@Nonametoday wrote:

PAs are far more and better educated than RNs

dee

[Nonametoday]

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@deedledeedeedle wrote:

NOT TRUE. Do your homework. 

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@Nonametoday wrote:

PAs are far more and better educated than RNs

dee

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@deedledeedeedle 

I did my homework when it was necessary.  Appears that nowadays they can get into the CRNP programs with lesser qualifications than PAs back in the day.  I personally have met some very highly qualified CRNPs and some who were not much better than a receptionist in a doctor's office.

You really have an ugly attitude and I hope I never have to see a medical professional with such a snarky attitude as yours.

[pepes mom]

@pitdakota The C in CRNP is Certified, so title is Certified Registered Nurse Practitioner.

Back when I was a graduate nurse, I worked on a monitored Thoracic Surgery Unit. We had a CRNP who, along with the Intern, managed the care of our patients. She was able to write orders for patient care and the nurses were allowed to carry out her orders. After she left our service for a steady hours job in the ER, a PA was hired. 

We were NOT allowed to carry out her orders. At that time,everything she wrote had to be co-signed by a physician. It made patient care rough. It was almost pointless to have her there. Thank goodness Pennsylvania changed it's rules regarding who can write orders.

I've had the opportunity to work with both good and not so good CRNP's and PA's. I've also been under the care of good and average CRNP's and PA's. When I had major shoulder surgery, I was seen post operatively by the PA for the first 3 visits. She was very nice, but my complaints of continued pain were dismissed as part of the healing process and I was told to focus on how much my range of motion had improved. Yes, it had, but I knew something wasn't right.

When I finally saw my actual surgeon on the 4th visit, he came into the room and declared that, after reading her notes, I look, feel, and am doing amazingly well. The former RN in me decided to set the record straight. First, I told him to never come into a room and declare that someone is doing amazingly well if you haven't spoken to the patient or examined the patient. I said ask the patient how they think they are doing, vs just declaring his opinion. Then I informed him of my issues and told him that I wasn't leaving his office until I had a script for a new MRI because something wasn't right. I wasn't asking for pain meds, I just knew my recovery was "off". Turns out I developed bursitis in a different bursa than the one they removed. I received a steroid injection and my recovery progressed well afterwards.

In hindsight, I should have informed the PA that I wanted to see my surgeon by the second visit, not fourth. After having words with my surgeon, he informed that no one had ever told him not to speak like that to a patient. After that, we got along beautifully. During my shoulder recovery, I developed a knee effusion. He gave me the option to treat it or have an MRI. When we discussed everything, one of the residents was in the room. I voted for the MRI because I am a big fan of knowing what Is going on before haphazardly treating something. He told that resident, she is a nurse and an informed decision maker. Write her out the script for the MRI.

Sometimes it's the squeaky wheel that gets the grease. As a patient, you have to advocate for yourself. Sometimes people think doctors are gods and would never question them. I say, if it something doesn't feel right, speak up. 

[pitdakota]

@pepes mom, thank you for that explanation.  That makes sense that it was the title that predates Advanced Registered Nurse Pracitioner.   Of course today, they are licensed as and called ARNPs.  

I hear you loud and clear about your remarks to the md.  Good for the nurse coming out in you.  lol  That is a good thing.

Reminds me of when I took my mother early into her diagnosis of dementia to a young neruologist for an initial evaluation.  After he had examined her, he called me into his private office there.  His remark to me was "poor thing she doesn't even realize she has kids".  I was a little surprised by that since although there were many challenges with her memory, perception, etc.  the one thing she did know at that point who I was.  So I asked him what made him come to that conclusion.  He was a little taken aback by my question and responded well of course I asked her if she had any kids and she told me no. 

Well this nurse had to explain to him that of course she didn't have any kids and with her dementia she would not be able to discern that he was actually asking her if she had any "children" or more specifically sons or daughters. Of course she didn't have kids, because kids are little ones. 

 I made a bet with him that if we brought her in there and he asked her if she had any sons or daughters she would answer correctly.  I was surprised when he actually agreed to take the time to do so.  Husband brought Mom back into the private office, he asked her the question.  Mom promptly responded well yes, I have a daughter she is right here.  Then she said my name, this is my daughter as if to introduce me to him.  LOL! 

BTW, good to see you and hope you are doing well.