Quote of the Day
"Why do we pay doctors big salaries to do what a nurse practitioner could easily do? Honestly I think that a nurse practitioner could easily handle what comes into an ER if they specialized in emergency medicine."
That's a bold statement.
That's a bold statement.
Labels: ER, health care crisis, nurses
posted by scalpel at 9:26 PM
23 Comments:
It's a double-edged sword. I don't agree that doctors are overpaid. But I do believe their talents are often wasted, writing scripts for the contraceptive pill, bandaging a sprained ankle and scribbling sick notes for the guy who has a headache and just wants to get out of work for a day. These sorts of routine visits are where a nurse-doctor hybrid should be used.
I think NPs and PAs are ideally suited for "fast track" sections of emergency departments. That's not to say they shouldn't get their feet wet in complicated stuff (with appropriate supervision). However, you can't replace the YEARS of training of a residency trained emergency room physician. Scalpel, hopefully, that wasn't a clipboard carrying administrator that made that remark.
Most (or, maybe, all) of our pre-emergency medicine residency program docs can't intubate and only put in a central line under diress. They use IR for lumbar punctures, and refer simple sore throats to ENT specialists for evaluation.
Some of the NPs that run the Fast Track used to work in other hospitals where they did central lines, tubed people, etc, but they're not allowed to use those skills in my hospital.
Gotta love it...would rather have no one do it than an NP. By no means are our NPs better at complicated patients than an emergency-trained MD though. Our non-ER ER docs just admit/refer/work up every benign whatever until every possible emergency is ruled out; anyone can do that.
I agree and disagree. Growing up, when I went to the family doctor, I preferred to see the NP because, quite frankly, she cared and seemed more knowledgeable than my doctor.
My mother-in-law is an NP and I would trust her to do some of the things that I do not trust some doctors to do and I know those docs equally as well.
I do think that doctors are invaluable resources as they spend much more time studying information that could save lives, but as far as the skills of a seasoned NP compared to the skills of a doc I trust them equally.
Of course I speak only from my limited experience. I do not think that docs are over paid though. They are paid well for their services.
I agree completely with Anonymous above. NPs and PAs are perfect for Fast Track, but I would take an ER doc for the complicated patients any day.
The one exception is that we have a PA in our hospital who all the docs seek out when a central line needs to be placed because this guy is God when it comes to putting a Sepsis line in, and he loves to get away from the cuts and scrapes and do some serious medicine.
All I can say is when I get into an MVA because I feel asleep on my way home from a night shift, I know who I want putting in my chest tubes.
Where the fully trained and experienced physician earns his pay is in the situation which at first glance appears to be simple/straightforward/amenable to management by protocol, but is actually unusual presentation of early sepsis/CVA/perforated viscus. An ER physician who picks a situation up like this 3 or 4 times per year easily justified her higher salary for writing work notes, Rx for Septra, etc., for most of her shifts. That type of sixth sense may develop in an extender over a decade or more of supervised experience, but is more likely to be present from the start in someone who has spent several years in EM training. It's not going to be there in the nurse who finished her Practitioner training last year and just hired on in the ED. This is the Achilles' heel of using extenders in EDs.
"NPs and PAs are perfect for Fast Track, but I would take an ER doc for the complicated patients any day."
Call me bias, but isn't one of the purposes of medical education/residency to be able to tell which patients are the complicated ones, or to pick up on small things that seem Fast Track but are actually pretty ominous?
"Call me bias, but isn't one of the purposes of medical education/residency to be able to tell which patients are the complicated ones, or to pick up on small things that seem Fast Track but are actually pretty ominous?"
Dear bias,
Yes that is true that MDs are trained to pick up on subtle hints, and there certainly are times when patients who need to have subtle hints picked up on end up in Fast Track, but the overwhelmingly, vastly huge majority of FT patients (at least with a good triage nurse) are cuts and scrapes and bumps and bruises that are as straightforward as you can get. It is really nice to get them seen by a PA or NP so that the patients who do have the potentially complicated complaints get seen by the MD.
nurses are not docs period. don't want to burst any nurse's bubble here but my money would be on the paramedics..they're the true practioners of emergency medicine
Dear Midwest woman,
Paramedics are the experts at getting you TO the hospital. They are extremely good for the first 15-20" of your emergency. Then you're going to need a doctor.
-whitecap nurse
Personally I think NP's have a role in fast tracks of ER's and primary care (with MD oversight when appropriate). The problem is when she states NP's can be trained to place lines, intubate, etc, etc. What girlvet appears not to realize is the training required to determine the appropriate setting for these procedures. As an old crusty surgeon stated to me back in my residency, "A monkey can be trained to surgery, it takes a 5 year general surgery residency to determine when NOT to do surgery". Her other statement below is just plain ignorant:
"Nurses are taught to look at the whole person. Doctors, for the most part, are taught to treat the physical. Nurses learn more about preventive care"
She is an ER nurse, I've got news, ER docs are TRAINED to deal with emergencies, not looking at the "whole person" or "preventive medicine". I can assure you, well trained FP and IM docs have oodles of training in preventive care and Do look at the whole person. To think otherwise is clueless as to what IM and FP (and peds)involves. The more I read ER nurse blogs the more I realize how utterly ignorant some are as to the world outside the ER.
I actually agree with this concept.
Besides, an MA can easily handle a nurse practitioner's job if they specialized in emergency medicine.
Come to think of it, a college senior that took a correspondence course in medicine could probably do the MA's job if the correspondence course was in emergency medicine.
I've got an idea! Lets replace all the emergency docs with college seniors who took a correspondence course in emergency medicine so that we can pay them minimum wage!
I think we should get some of those Japanese fembots to use as triage nurses. That would be awesome.
Why are all the docs M.D.'s? Lest we forget our D.O. brethren?
I'm a bold typea gal..
Right. Pediatric brain surgery is easy too. All you have to do is specialise in it. It will take 7 -8 years after your 4 year NP program and you would be great.
"I think we should get some of those Japanese fembots to use as triage nurses. That would be awesome."
QFT.
Aren't D.O.'s witch doctors? They're too touchy, feely too. With all their tonics, tinctures and rubs.... rubbish! I think I'd rather be treated by a medical examiner like Ducky from that TV show NCIS. He at least has an English accent and wears bow-ties.
;-)
white cap nurse what i meant was think paramedics might be as experienced as er nurses....besides my point exactly i want a doc not a n.p. or any other combination of letters behind a name other than m.d. when i hit the e.r.
All I can say is when I get into an MVA because I feel asleep on my way home from a night shift, I know who I want putting in my chest tubes.
Me too. And that would be: whoever can do it best, regardless of the initials after his/her name.
Going off of Nurse K's comment for mine, for the most part.
midewest woman says: "what i meant was think paramedics might be as experienced as er nurses"
I don't want an ER nurse showing up to my accident in the ambulance and I don't want a Paramedic walking into my room in the ER to hang blood or access a port.
Paramedics are experienced at on-scene stabilization and initial treatment in tough environments. ER Nurses are experienced at continuing (and sometimes initial) stabilization and important procedures.
I like spaghetti. I like cake. They each have their place.
Each profession has very distinct and important qualities and to try to equate them is just silly.
Pure idiocy, particularly the "whole person" nonsense. And RNs knowing more than physicians about preventative care? LOL! Right, 2 years of community college = 4 years of medical school + 3 years of residency.
They should allow these cocky fools to sit for the IM/EM/FP boards. Should be easy, right? Then they can practice independently from a physician and accept the same liability when they mess up.
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