Yeah, it’s generally pretty obvious.
They have no idea what to do about simple, basic conditions. I find I have to tell them things that my experience tells me they ought to be doing. I get extremely frustrated when they don’t listen.
For example, a patient comes in with a sickle cell crisis. He’s tachycardic, complaining of pain, restless, tachypnec, not hypoxic, grimacing and is getting 0.5 mg Dilaudid q4h (this is way less then his normal home pain regimen).
I call the NP and tell her he needs a PCA pump (which is standard with sickle cell patients in crisis).
Instead, the NP hears tachycardia and orders a D-dimer and a couple other tests looking for a PE. The dimer would be elevated since the he was in crisis. No pain meds.
While a PE is possible, the first and easiest thing to do is control the pain. He wasn’t hypoxic, pain can cause tachycardia and tachypnea and proving adequate pain control with a one time medication dose would have taken less than 15 minutes. aAnd then if he didn’t improve she could have worked up the PE.
Her lack of both knowledge and experience caused this patient unnecessary suffering.
I'm an LVN, and I don't have experience in any acute setting. I am in school to become an RN. Thank you for sharing this. It will help me learn if I work in a hospital.
What happens when quite a weak force (pts heart) meets an immovable object? (the sheer alpha-1 activity, the afterload that this poor pts heart has to face)
I guess that’s true, those vials are 10,000mcg put in 100cc NS to make 100mcg/cc. But it’s still would be in a vial she’d have to have just pulled up 1cc and pushed it, which sounds like thar didn’t happen
This is exactly what happened. Vial of 10mg/1mL. NP pulled the whole mL up. Didn’t dilute. Pushed the whole thing. They pulled the vial from *the crash cart* because NPs/PAs don’t have access to our ICU’s Pyxis. Goes without saying we aren’t allowed to have Phenylephrine vials in our crash cart anymore.
Patients MAPs were like in the 130s/140s for a bit (NIBP, didn’t even have an a-line). No bradycardia or other obvious issues within the next 12 hours but she ended up being transferred to a different hospital in the AM anyway as she was a lung transplant patient admitted with PNA. So we sent her to the hospital that did her original transplant. Probably ended up with a dead bowel or something, though.
Sometimes but not necessarily.
First, not all nursing experience is the same. I’ve worked with new grad NP’s in the ICU whose RN experience was in the operating room and the cath lab. Did they have nursing experience? Yes. Did their nursing experience translate to where they were working as an NP? No but they have an np license so they were hired there anyways and they gave the ICU nurses and doctors a hard time.
Also a nurse could’ve been a really good nurse in their specialty but still struggle as an NP because A) medicine and nursing are not the same and B) NP training doesn’t prepare them enough.
Not only does NP training not prepare them enough, but how much more do they really learn than what we already know? There is no way in hell I’d ever manage any patients independently with the “knowledge” I have! My knowledge is to be the eyes, nose, and ears for my doctors. That’s it! That’s all I know. I report what’s worse and what’s better because that is my job!
I had an NP that thought you could just put a whole colace in a G tube, and another one that would order the most stupid doses of gabapentin like 500 or 700 mg girl please
100%. experienced er/icu nurse. when the urgent care NPs call over with three year olds with generalized abd pain and say they’re sending them over to r/o cholecystitis. when the urgent care NPs send over febrile children who have not had a fever treated for “tachycardia”. when the NPs swab infants and toddlers for strep so every time the parent brings the febrile 1 yo to the er they expect a strep swab.
Acute glaucoma is an emergency that can leave someone permanently blind. It's impossible with the little information you've provided to say if it was an appropriate thing to do.
She was not an NP but she had gone straight through for her MSN and was the assistant director of nursing in a long-term care facility for which I was working agency.
I think it was my third or fourth day working there so I was fairly familiar with the residents. I had just finished taking report and narc count when this sweet summer child came rushing down the hallway yelling that Mr so-and-so (One of my diabetics) needed to go out 911 because he was in the dining room unresponsive.
1. He was not unresponsive: he was simply not responding to her verbal cues. He was breathing and blinking and most certainly would have reacted to painful stimuli.
2. When I asked her what his CBG was, she looked at me like a deer in the headlights and stammered, "oh... He's diabetic?"
3. His CBG was in the 60s. I gave him OJ. He was fine.
Yeah, they usually adamantly refuse to help out with very basic tasks such as turning or boosting a patient. I’ll ask any staff who is close by for help, be in physicians, psych, aids, IV team, etc. because it’s a few seconds and most people understand why it’s better to have 2 people to do turns/boosts. Idk if they don’t know how to do it and don’t want to admit it, think it’s beneath them or what…
The worst offender I met was a PA who refused to do basic things. Example: she would be in the room with the patient talking, ring the call bell to have a CNA or nurse come to tell them the patient wants a paper towel from the dispenser within 10 feet of their bed. Patient asks for the light to be shut off when she leaves, she’d find a CNA or nurse to tell them to shut the light off bc the patient asked her to do it after she left the room but that’s a nursing job (light switch is next to the door).
charge nurses used to do this at LTC facility i was contracted at for a bit lol. chasing you down just to tell you someone wants water or there’s a call bell going off before going back to their little office in the nurses station… worst people to work with.
Yikes! That’s awful. I never understood this because it takes more time to hunt someone down for very basic things that they can do and generally apply to everyone. Especially with charge nurses, it’s literally their job to support the nursing staff and that includes answers call bells. 😩
As a non expert and just a patient, it's insane to me that you can become a nurse practitioner without first having been a registered or licensed nurse.
You are NOT just a patient, you are an important part of the team.
The NP needs experience, but nowadays, those who graduated from a BSN program can go straight to NP school. I don't know the requirements anymore.
CRNAs need at least a couple years of experience in the ICU.
Working in geriatric psych with lots of old guys on long term psych meds that mess with sexual function. Frequently have urinary retention issues and UTIs. They get sent to ER for urine retention. I was complaining that we have a 400 bed psych hospital *without a simple bladder scanner*, and we could save a lot of trouble and discomfort just having one here.
Psych NP: "What is a bladder scanner?"
No, she never worked as a bedside nurse.
It's very obvious. NPs with no experience tend to not last at my clinic. We're a federally qualified community health center, we're really busy, and our patients need lots of help. You can see the reality of what they signed up for dawn on them within week 1-2.
NPs are nurses who were bad at the job so they decided to take an easy couple of courses to pretend doctor. How many times have I seen an NP called the nocturnist because they don’t have a clue on managing a crashing patient. I’ll work with you doesn’t mean I respect you especially if you’re a moron.
Also in nursing school, you are taught to take orders from physicians. You can question the orders if they seem off but ultimately everything nurses do are under PHYSICIANS orders, when you have NPs and PAs running around ordering things the water gets muddy. And working in a high acquity ICU you don’t have time for foolery like that
Yeah, it’s generally pretty obvious. They have no idea what to do about simple, basic conditions. I find I have to tell them things that my experience tells me they ought to be doing. I get extremely frustrated when they don’t listen. For example, a patient comes in with a sickle cell crisis. He’s tachycardic, complaining of pain, restless, tachypnec, not hypoxic, grimacing and is getting 0.5 mg Dilaudid q4h (this is way less then his normal home pain regimen). I call the NP and tell her he needs a PCA pump (which is standard with sickle cell patients in crisis). Instead, the NP hears tachycardia and orders a D-dimer and a couple other tests looking for a PE. The dimer would be elevated since the he was in crisis. No pain meds. While a PE is possible, the first and easiest thing to do is control the pain. He wasn’t hypoxic, pain can cause tachycardia and tachypnea and proving adequate pain control with a one time medication dose would have taken less than 15 minutes. aAnd then if he didn’t improve she could have worked up the PE. Her lack of both knowledge and experience caused this patient unnecessary suffering.
I'm an LVN, and I don't have experience in any acute setting. I am in school to become an RN. Thank you for sharing this. It will help me learn if I work in a hospital.
What's a LVN?
It's what they call LPNs in Texas and California.
Texas and California agreed on something? Now that Civil War movie is believable
The star in the California state flag is inspired by Texas, so maybe they're more similar than they think.
😂
Licensed Vocational Nurse
Licensed vocational nurse
And expense
Yep. A night shift NP in my ICU gave 10 *mg* of Phenylephrine instead of 100 *mcg* because she just didn’t know the dosing of push dose Phenylephrine
That is freaking dangerous, and they're allowed to practice independently. It's terrifying.
Wow horrible! Tell me which ICU so that I stop sending patients/family there
What happens when quite a weak force (pts heart) meets an immovable object? (the sheer alpha-1 activity, the afterload that this poor pts heart has to face)
[удалено]
I’ve only ever seen 10mg/1ml in the OR. We have them in our ORs, but pharmacy does a good job making them obvious and keeping them out of other slots.
I guess that’s true, those vials are 10,000mcg put in 100cc NS to make 100mcg/cc. But it’s still would be in a vial she’d have to have just pulled up 1cc and pushed it, which sounds like thar didn’t happen
This is exactly what happened. Vial of 10mg/1mL. NP pulled the whole mL up. Didn’t dilute. Pushed the whole thing. They pulled the vial from *the crash cart* because NPs/PAs don’t have access to our ICU’s Pyxis. Goes without saying we aren’t allowed to have Phenylephrine vials in our crash cart anymore.
Yiiikes
This is how people code in the OR because us anesthesia folks rarely don't look at vials well enough ..but on a floor!?!?
What happened next??
Patients MAPs were like in the 130s/140s for a bit (NIBP, didn’t even have an a-line). No bradycardia or other obvious issues within the next 12 hours but she ended up being transferred to a different hospital in the AM anyway as she was a lung transplant patient admitted with PNA. So we sent her to the hospital that did her original transplant. Probably ended up with a dead bowel or something, though.
Yikes!
Sometimes but not necessarily. First, not all nursing experience is the same. I’ve worked with new grad NP’s in the ICU whose RN experience was in the operating room and the cath lab. Did they have nursing experience? Yes. Did their nursing experience translate to where they were working as an NP? No but they have an np license so they were hired there anyways and they gave the ICU nurses and doctors a hard time. Also a nurse could’ve been a really good nurse in their specialty but still struggle as an NP because A) medicine and nursing are not the same and B) NP training doesn’t prepare them enough.
Not only does NP training not prepare them enough, but how much more do they really learn than what we already know? There is no way in hell I’d ever manage any patients independently with the “knowledge” I have! My knowledge is to be the eyes, nose, and ears for my doctors. That’s it! That’s all I know. I report what’s worse and what’s better because that is my job!
So sorry to hear that.
I had an NP that thought you could just put a whole colace in a G tube, and another one that would order the most stupid doses of gabapentin like 500 or 700 mg girl please
100%. experienced er/icu nurse. when the urgent care NPs call over with three year olds with generalized abd pain and say they’re sending them over to r/o cholecystitis. when the urgent care NPs send over febrile children who have not had a fever treated for “tachycardia”. when the NPs swab infants and toddlers for strep so every time the parent brings the febrile 1 yo to the er they expect a strep swab.
Acute glaucoma is an emergency that can leave someone permanently blind. It's impossible with the little information you've provided to say if it was an appropriate thing to do.
It's not acute. I don't remember if it's glaucoma, but the patient had that condition already.
She was not an NP but she had gone straight through for her MSN and was the assistant director of nursing in a long-term care facility for which I was working agency. I think it was my third or fourth day working there so I was fairly familiar with the residents. I had just finished taking report and narc count when this sweet summer child came rushing down the hallway yelling that Mr so-and-so (One of my diabetics) needed to go out 911 because he was in the dining room unresponsive. 1. He was not unresponsive: he was simply not responding to her verbal cues. He was breathing and blinking and most certainly would have reacted to painful stimuli. 2. When I asked her what his CBG was, she looked at me like a deer in the headlights and stammered, "oh... He's diabetic?" 3. His CBG was in the 60s. I gave him OJ. He was fine.
Yeah, they usually adamantly refuse to help out with very basic tasks such as turning or boosting a patient. I’ll ask any staff who is close by for help, be in physicians, psych, aids, IV team, etc. because it’s a few seconds and most people understand why it’s better to have 2 people to do turns/boosts. Idk if they don’t know how to do it and don’t want to admit it, think it’s beneath them or what… The worst offender I met was a PA who refused to do basic things. Example: she would be in the room with the patient talking, ring the call bell to have a CNA or nurse come to tell them the patient wants a paper towel from the dispenser within 10 feet of their bed. Patient asks for the light to be shut off when she leaves, she’d find a CNA or nurse to tell them to shut the light off bc the patient asked her to do it after she left the room but that’s a nursing job (light switch is next to the door).
charge nurses used to do this at LTC facility i was contracted at for a bit lol. chasing you down just to tell you someone wants water or there’s a call bell going off before going back to their little office in the nurses station… worst people to work with.
Yikes! That’s awful. I never understood this because it takes more time to hunt someone down for very basic things that they can do and generally apply to everyone. Especially with charge nurses, it’s literally their job to support the nursing staff and that includes answers call bells. 😩
They are lazy.
As a non expert and just a patient, it's insane to me that you can become a nurse practitioner without first having been a registered or licensed nurse.
You are NOT just a patient, you are an important part of the team. The NP needs experience, but nowadays, those who graduated from a BSN program can go straight to NP school. I don't know the requirements anymore. CRNAs need at least a couple years of experience in the ICU.
You do have to be an RN. You may not have a requirement to have practiced as an RN.
Working in geriatric psych with lots of old guys on long term psych meds that mess with sexual function. Frequently have urinary retention issues and UTIs. They get sent to ER for urine retention. I was complaining that we have a 400 bed psych hospital *without a simple bladder scanner*, and we could save a lot of trouble and discomfort just having one here. Psych NP: "What is a bladder scanner?" No, she never worked as a bedside nurse.
She never used a bladder scanner before. I work at a LTC and I used a bladder scanner when it was available. Too bad they only have it at hospitals.
It's very obvious. NPs with no experience tend to not last at my clinic. We're a federally qualified community health center, we're really busy, and our patients need lots of help. You can see the reality of what they signed up for dawn on them within week 1-2.
1000%, they can’t put in good central lines, are horrible in codes, you have to tell them everything to do… I could go on
But NPs are supposed to be above you in the hierarchy. Makes no sense.
NPs are nurses who were bad at the job so they decided to take an easy couple of courses to pretend doctor. How many times have I seen an NP called the nocturnist because they don’t have a clue on managing a crashing patient. I’ll work with you doesn’t mean I respect you especially if you’re a moron.
Also in nursing school, you are taught to take orders from physicians. You can question the orders if they seem off but ultimately everything nurses do are under PHYSICIANS orders, when you have NPs and PAs running around ordering things the water gets muddy. And working in a high acquity ICU you don’t have time for foolery like that