Heart of a nurse, brain of a doctor thread

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steross

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!?!?!?!?!? What is this? Context please.

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Nurse practitioner schools.

It went from a way to further your education as a nurse to a big money-making racket that is making "doctors" out of nurses with 1-2 years of online course work instead of many years of hospital-based training.
The online schools make a ton of money because they can charge $25K a year in tuition for nothing more than putting out online coursework. In the past, NP school was for very experienced nurses and they had to actually go to school. Now, brand new nurses can do this online and the schools are multiplying rapidly because it is easy money.

But, they need to have some observation time from a doc in a clinic to get a degree. Even that is changing and many now let them do it with another NP. But, in some states if the NP wants to practice on his/her own, in they need to find a physician "collaborator." This is the person whose malpractice takes the hit when the nurse screws up because people want to sue doctors, not nurses. This is becoming very hard to find because doctors don't want to lose their license because they took money from a poorly trained nurse pretending to be a doctor. So, they are now getting advised to scour the physician disciplinary lists to find a desperate doc that will whore out his license for $500-1000 a month so that a nurse can practice medicine.

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And, to make matters worse, the big private-equity based corporations realize this is a huge moneymaker so they staff EDs with these practitioners instead of hiring ER docs. They then force the ER doctor co-sign the charts as a supervisor. But, the reality is that if an ER is busy enough for two docs, the one doc is not really supervising, just working at the same time as the NP.

Sometimes, they claim "rural" and no doctor available and staff ERs with only these undertrained NPs.

Here is a case from El Reno which, at 30 min outside of OKC, is not exactly rural. It is 30 min from my apartment, I would work there if they did not underpay. I'll put if in a spoiler tag just because it is long and I've already talked too much for the pic thread. Watch this space, this is going to be a HUGE problem in American health care quality over the next decade. It hurts patients, docs, NPs that were properly trained, and gains money for the new nurses taking the short cut to medical practice and the corporations that take advantage but shift the liability to their employee doctors.
Apr 1, 2019
#1
Case below that any 3rd year med student could manage independently and literally impossible to miss by anyone who has experience beyond MS3.

"Below is a case that happened in my state of Oklahoma that just settled where NP did not know how to manage at an ER, she was an FNP working in ER 2nd to her last shift as she had been terminated but they allowed her to work her 30 days. One of the defendants that was listed was the supervising physician. The 19 yo died, Jury awarded family $6 million. Textbook case of PE

This happened in my state of Oklahoma!!!! This makes me sad, terrified, angry for the patient and her family. This NP is now working in the ER in Iowa. No disciplinary action against this NP!

Guess who is listed as the defendant? The supervising physician!!

“On Thursday March 21, 2019, an Oklahoma County jury returned a verdict for $6,190,000 in favor of the family of 19-year-old Alexus Ochoa-Dockins and against Mercy Health and other defendants in a medical malpractice case arising from the 19-year old girl’s alleged wrongful death.

Alexus Ochoa-Dockins graduated from Del City High School in May of 2014. Alexus was a National Honor Student and outstanding basketball player

In September of 2015, Alexus had just begun her sophomore year at Redland College. After she and her boyfriend went home for the weekend to visit family, they returned to El Reno on Sunday, September 28, 2015.

After arriving back to the college dormitory, Alexus complained of chest pains and shortness of breath. Her boyfriend testified at trial that Alexus told him “I can’t breathe.” She then passed out. Her boyfriend called 9-1-1.

Melissa Belanger, the Mercy EMS paramedic who responded and who testified at trial, reported Alexus had fainted, had shortness of breath, chest pain, low oxygen saturation, fast heart rate and fast breathing when she transported her to Mercy Hospital El Reno. According to medical expert testimony at trial, these were all classic signs and symptoms of a pulmonary embolism, a blood clot blocking blood and oxygen to the lungs. Additionally, Alexus was on birth control which according to expert trial testimony is a known risk factor for developing a pulmonary embolism.

At trial, Ms. Belanger, the paramedic, testified she called Mercy Hospital El Reno enroute and told the nurse she was on her way with a 19-year-old female who she believed had a pulmonary embolism and would need a CT.

The only medical provider in the Mercy Hospital El Reno emergency room was Antoinette Thompson-Ducasse, a family nurse practitioner. A family nurse practitioner is an advanced practice registered nurse who receives special training, education and certification in an area of specialty. According to Family Nurse Practitioner Thompson’s testimony shown at trial, she had never taken any classes in her nurse practitioner school for acute care or emergency medicine. She was only a family nurse practitioner. However, 8 months earlier Mercy granted her privileges to provide care and treatment to acutely and critically ill patients in the ER at Mercy El Reno. In fact, according to trial testimony, she was often the only medical provider in the emergency room in El Reno.

Initially, Thompson ordered a CT scan of the chest along with a urine sample. While in the bathroom to give the urine sample, Alexus passed out again. When the urine sample came back it showed presumptive positive for meth. However, the test was negative for amphetamine, which was unusual. According to testimony, Thompson and others knew the test may be inaccurate. Alexus, her boyfriend and her mother told Thompson something had to be wrong with the test because she did not do drugs. She was an athlete. At trial the testimony showed that nurses at Mercy did not believe Alexus exhibited behavior consistent with someone taking meth. At the request of Alexus’s mom, Thompson obtained another urine sample, which came back nagative for meth. Despite the negative meth test, Thompson cancelled the chest CT that would have diagnosed the pulmonary embolism and diagnosed Alexus with meth use and admitted Alexus overnight. An autopsy report confirm that Alexus had not taken any drugs.

Evidence showed at 12:22 a.m. after Alexus had been in the hospital for 8 hours Thompson finally ordered a CT scan of the chest but only after consulting by phone with another medical provider. However, Thompson did not order the scan “stat” or urgent. As a result, the radiologist did not read and report the results back to Thompson until 2:30 a.m. the morning of September 28th. The CT chest showed blood clots or pulmonary emboli in both lungs. Alexus was finally transferred to OU Medical Center and arrived a little after 3:30 a.m. Alexus was at the point of death when she arrived at OU Medical Center. Doctors at OU Medical Center attempted to give her the clot-busting drug tPA. It was too late. Alexus died at 5:26 a.m.

Shockingly, evidence at trial showed Mercy had terminated Thompson on September 1st for quality/safety concerns-27 days before Alexus showed up at the Mercy El Reno ER. The termination was effective October 1 as the contract required 30 days notice. The evidence showed Mercy would be required to pay Thompson during the 30 days whether she worked or not. Mercy decided to allow her to work during this 30 days instead of having another provider work during this period. Thompson was working her next to the last shift when she saw Alexus.

According to testimony, Alexus received no treatment for her blood clots in her lungs during the 11 hours she was at Mercy Hospital El Reno.

According to Glendell Nix, the attorney who represented the family, “The evidence at trial showed Alexus had all the classic symptoms of a pulmonary embolism which could have been promptly diagnosed with a simple blood test and CT scan. The evidence at trial showed that had she been diagnosed and treated during the first eight hours she would have survived.”

At trial, the family presented evidence the family nurse practitioner was not properly trained, educated or credentialed to diagnose such life-threatening conditions as a pulmonary embolism even though Mercy put her in charge of the emergency room. As a result, Alexus did not receive appropriate blood thinners or any other treatment to dissolve the blood clot.

Nix said, “The family is hopeful that the lawsuit and verdict will lead to changes at Mercy to ensure there are appropriately qualified medical providers at all Oklahoma hospitals so this kind of tragedy does not happen to another family.”

https://www.oscn.net/dockets/GetCas...6rwgym1WoGeChmEn7MGgkiu4vKCR168QxP0bqXWYQRUmM
 

steross

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Do you feel that this is caused by the rising cost of education. The entire cost factor has changed my daughter's education. One is in nursing school and the other has changed direction from being a doctor to taking her LPN in high school, to RN, and then to nurse practitioner.
No, not really. For most people, it is pretty stupid to go to medical school now.


Let's say you want to be a professional pilot. This isn't correct but lets say you have two options:

Option 1: Go to navigator school which is 2 years of college then 2 years of navigator school. Then you can take an online pilot/navigator course for 2 more years and you get to fly almost any type of plane you want. And, you can just change types of planes when you want. But at this point you just don't get to fly long haul transcontinental flights.

Option 2: Go to pilot school. You need 4 years of college. Then you need 4 years of pilot school. Then you have to pick what type of pilot you want to be and spend 4-7 more years learning that plane and forever you only fly that type of plane.

Now, when you get done with option 2, you are paid more than option 1. But, you spent a lot more time getting there. And, if you don't like it, sorry, it was your choice a decade ago.

I don't think cost is the issue as both end up pretty costly. It is just a more intelligent career choice for most people with the way the politics is going now. Nurses are seen as kind and compassionate. Doctors as arrogant and money-grubbing. This has allowed massive monetary and political gains for NPs. And, they were very clever to do a bunch of studies back when NPs were working in supervised environments and had better schooling that showed their care was "equivalent" to doctors. They shove those in the faces of politicians all the time. But, does that make sense? I spent 120 hours a week in the hospital for years of supervised training by academic physicians. Can someone who took an online course for 18 months really be equivalent to that? If so, why make anyone do it?
 

steross

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For those that do not know, the thread title is a lobbying slogan:

Sort of insult docs by saying we don't have as much heart, and nurses for saying they don't have as much brain.
 

RxCowboy

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For those that do not know, the thread title is a lobbying slogan:

Sort of insult docs by saying we don't have as much heart, and nurses for saying they don't have as much brain.
Nurses think they have the market cornered on caring.

My biggest problem with NPs is they learn from a nursing model and not from a medical model. That, and they are being cranked out like cockroaches in programs that don't even have close to the proper resources to teach them effectively.

We have too many schools of pharmacy and too many are under-resourced. Absolutely none would be able to get away with what these NP programs get away with. None. Ever.
 

jakeman

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Nurses think they have the market cornered on caring.

My biggest problem with NPs is they learn from a nursing model and not from a medical model. That, and they are being cranked out like cockroaches in programs that don't even have close to the proper resources to teach them effectively.

We have too many schools of pharmacy and too many are under-resourced. Absolutely none would be able to get away with what these NP programs get away with. None. Ever.
There is a dude in the little town I live in that opened an immediate care here. Then he opened another one. Then another one. Then another one. Then he built a really nice building and moved 2 of them in together in a more central location. He’s an NP. Nice guy. He’s also apparently getting filthy rich.

I don’t know what that really has to do with your thread, except I didn’t know he wasn’t a doc for about the first dozen times I went in there for a shot or a quick script.
 

RxCowboy

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There is a dude in the little town I live in that opened an immediate care here. Then he opened another one. Then another one. Then another one. Then he built a really nice building and moved 2 of them in together in a more central location. He’s an NP. Nice guy. He’s also apparently getting filthy rich.

I don’t know what that really has to do with your thread, except I didn’t know he wasn’t a doc for about the first dozen times I went in there for a shot or a quick script.
I don't think either of us are saying that there aren't good ones, there are. I've worked with good ones. We're talking about what is happening in general.
 

RxCowboy

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Do you feel that this is caused by the rising cost of education. The entire cost factor has changed my daughter's education. One is in nursing school and the other has changed direction from being a doctor to taking her LPN in high school, to RN, and then to nurse practitioner.
The proximate cause is the lack of primary care providers. The global need for primary care is more than MD/DO, NP, PA-C, Pharm.D., etc. can provide. The problem with mid-level practitioners like NP/PA is their programs are geared towards routine primary care, but the majority of them end up working in other-than primary care. As many of you know, the redhead is a PA-C. She was hired down in South GA by an OB-Gyn practice and was told that she would be handling primary care (OB-Gyn provides a LOT of primary care for women) and routine procedures (pap smears). She ended up doing almost anything but that. She acted as a consultant for a patient with a reproductive tract cancer (can't remember specifically which one), and was the only provider to see a pregnancy for an obese, smoker, 40 year old that didn't show up for prenatal care until the third trimester, until she delivered. These were not things for which she was trained. So, midlevels end up in practices for which their training is woefully inadequate.

As far as clinical pharmacists, good luck getting hired for an infectious disease or oncology position unless you've done an infectious disease or oncology residency. It ain't happenin'.
 

RxCowboy

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Do they have prescription authority? Are there no pharmacology requirements?
Generally, yes. It is highly variable by state as to exactly what they have to do to have prescriptive authority. Some states they only need to have the degree and the license. They are pushing nationally to be independent practitioners so they can hang out their own shingle without a collaborating physician. My guess they will eventually get it.
 

bleedinorange

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Generally, yes. It is highly variable by state as to exactly what they have to do to have prescriptive authority. Some states they only need to have the degree and the license. They are pushing nationally to be independent practitioners so they can hang out their own shingle without a collaborating physician. My guess they will eventually get it.
Wow. Sounds like a potential train wreck. Diagnosing illness and prescribing meds beyond garden variety ailments is complicated under any circumstance for Drs. I can't imagine a nurse being prepared for either outside educational/internship/residency requirements.
 

jakeman

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I don't think either of us are saying that there aren't good ones, there are. I've worked with good ones. We're talking about what is happening in general.
I’m agreeing with both of you.

I thought I was being treated by an MD. I wasn’t.

Nobody ever told me he was an MD, but there wasn’t anything ever said or hanging on a wall that said he wasn’t either. I wonder how many people get seen by a NP in either a walk up clinic or an ER that think they’re seeing a doc?

I could tell a long winded story about getting bucked off a horse and seeing a NP in a little ER in Colorado for a shattered wrist. She was going to reduce it and cast it and send me back up the mountain before an X-ray tech called a surgeon in Durango and had him talk her out of it. When she went to take the call the tech told me she wasn’t an MD and if she put a cast on my wrist I might have lost my arm. I think that might have been when I learned everyone in a white coat wasn’t a Dr. When she got back she put a sugar splint on it and told me to go see a surgeon as soon as I could get to one.

I’m not sure we should be letting NP’s practice the same ER medicine as a doc with close to a dozen years of training.
 

RxCowboy

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I thought I was being treated by an MD. I wasn’t.
I always make sure that patients know I'm a pharmacist when I begin the relationship. Sometimes they forget. To not properly present yourself is unethical.

Glad the x-ray tech caught the error. We had to get the redhead out of the OB-Gyn practice because she was doing too many things she wasn't trained for and she didn't have appropriate support from the physicians. Something bad was inevitable. To her credit, she knew she was over her head.
 

RxCowboy

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Wow. Sounds like a potential train wreck. Diagnosing illness and prescribing meds beyond garden variety ailments is complicated under any circumstance for Drs. I can't imagine a nurse being prepared for either outside educational/internship/residency requirements.
That's the reason for the thread. These online programs are cranking out NPs that are woefully under-trained. They simply do not even begin to have the resources to train them properly. Yes, people are being harmed by errors. There are over 7k deaths per year from misprescribing (not all due to NPs admittedly) alone. Medical errors kill people.
 

steross

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I’m agreeing with both of you.

I thought I was being treated by an MD. I wasn’t.

Nobody ever told me he was an MD, but there wasn’t anything ever said or hanging on a wall that said he wasn’t either. I wonder how many people get seen by a NP in either a walk up clinic or an ER that think they’re seeing a doc?

I could tell a long winded story about getting bucked off a horse and seeing a NP in a little ER in Colorado for a shattered wrist. She was going to reduce it and cast it and send me back up the mountain before an X-ray tech called a surgeon in Durango and had him talk her out of it. When she went to take the call the tech told me she wasn’t an MD and if she put a cast on my wrist I might have lost my arm. I think that might have been when I learned everyone in a white coat wasn’t a Dr. When she got back she put a sugar splint on it and told me to go see a surgeon as soon as I could get to one.

I’m not sure we should be letting NP’s practice the same ER medicine as a doc with close to a dozen years of training.
I'm on a doctor group where people report the cases that have come to them from NPs and it is shocking.
And, I'm not being all high and mighty as I know that docs can screw up at times also. But some of these things are just insane. For example from today. A newborn baby brought to the ER because of a rash for a second opinion. The day prior had seen an NP in the urgent care and was diagnosed with poison ivy. Now, poison ivy in a newborn is all but impossible because the rash occurs on secondary exposure after primary exposure. A rash in the winter on a newborn.... well duh. Luckily the mother was smart enough to realize that made no sense and took the baby back in. She was diagnosed with the obvious neonatal herpes and was admitted to pediatric infectious disease for IV antivirals to prevent the devastating illness that would have been.
 
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So was not aware of this being an issue, but I rarely go to the doctor (NP??).

The thread is very informative but begs the question....so what do we do? Short of complaining to congressmen which will get nowhere, what can be done to change it? Is it legal to ask to see credentials and/or ask to see an actual doctor?
 

RxCowboy

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So was not aware of this being an issue, but I rarely go to the doctor (NP??).

The thread is very informative but begs the question....so what do we do? Short of complaining to congressmen which will get nowhere, what can be done to change it? Is it legal to ask to see credentials and/or ask to see an actual doctor?
I don't know that we can fix it. Nurses are an incredibly powerful lobby.
 

steross

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So was not aware of this being an issue, but I rarely go to the doctor (NP??).

The thread is very informative but begs the question....so what do we do? Short of complaining to congressmen which will get nowhere, what can be done to change it? Is it legal to ask to see credentials and/or ask to see an actual doctor?
Yes, that is exactly what you do.

It really frustrates me when they call themselves "doctor." I'm all for giving the honorific to those that earned it such as PhDs etc. But in a clinical setting, people think it means a medical doctor so it should not be used there if you aren't one.
 

steross

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I don't know that we can fix it. Nurses are an incredibly powerful lobby.
Yes, yes they do:

WASHINGTON — President Donald Trump today ordered federal officials to consider pegging Medicare reimbursement more closely to time spent with patients, seeking to address potential pay disparities between physicians and other healthcare professionals.

President Donald Trump

These directives are among the tasks Trump gave to the Department of Health and Human Services (HHS) in an executive order. The order also demanded HHS develop several proposals related to insurer-run Medicare Advantage, including one regarding payments for new technologies.

Trump signed the executive order after giving a speech at a rally in Florida.

The executive order gives HHS a 1-year deadline to propose a regulation that Trump describes as intended to let healthcare professionals spend more time with patients.

This regulation is meant to ensure that services, whether done by physicians, physician assistants (PAs), or nurse practitioners, "are appropriately reimbursed in accordance with the work performed rather than the clinician's occupation," the order said.

The order also tasks HHS with proposing a regulation to end what Trump called Medicare's "burdensome" requirements that are "more stringent" than federal and state laws require. The president intends to remove barriers that keep some personnel "from practicing at the top of their profession."


https://allnurses.com/huge-step-forward-nps-t707774/