RN vs. MD

[babynurse1]

Thanks! That's nteresting. Good to know! I will keep that in mind.

Part of me wants a little revenge on the endocrine community that told me I wasn't sick, I was nuts, that my BLA was a death sentence, by being able to stand toe to toe with them.

There is also nurse anesthetist and certified nurse midwife if you are interested in either one of those fields. Our CNM's share a practice with MD's but see their own patients, order their own labs, tests, prescriptions etc.

 

[Pea-n-Me]

Maybe we just started off on the wrong foot. My joke about "call the doctor stat" obviously rubbed you the wrong way.

I certainly did not mean to imply that all we do is call the MD. It was just a little bit of ironic sarcasm on my part to say "call the doctor stat" on a thread entitled RN vs MD.

Mea culpa.

No, not your fault. I just get very passionate about nursing and others' perceptions of nursing. Maybe too much sometimes. I'm sorry I upset you. I'm sure we'd get along just fine IRL. One of the things I love about nursing is the cameraderie I share with my fellow nurses. We all may approach our work a little differently, but we all have so much to offer in our own ways. Watching and being a part of the amazing work I see nurses do every working shift is part of what makes me passionate about nursing. So it's all good.

 

[Pea-n-Me]

Thanks! That's nteresting. Good to know! I will keep that in mind.

Honugirl, I also thought that when I read the post that npmommie quoted, but for a different reason than the one she posted from her perspective as an NP.

What I would tell you is to not underestimate the good you can do as an RN (even a plain ole' RN) in the endocrine community. One of the roles that nursing plays is that of patient advocate. That means that, as an RN, you help patients understand what things mean and what they need to do to take care of themselves. It's actually one of the things I've become expert at during the course of my career. It's rewarding to be able to sit down with patients and families and explain things in such a way that they finally "get it", sometimes for the first time - even in patients that have had a disease for a long time. You CAN make a difference, for sure.

Patients also like to be taken care of by people who've had medical issues to deal with themselves because they feel like their frustrations and pain, etc, is understood. I take care of patients with life threatening illnesses and when (and if) I share with them that I've had one, too, it's like a sigh of relief comes over them. I've kind of always felt that a prerequisite to taking care of patients should be having to be in that bed yourself first to experience things from a patient's perspective. (This was an interesting experiment I came across recently, speaking of that.) Additionally, nurses not only work in hospitals and doctors offices and such, they start their own businesses and things like that, usually as the result of seeing a need. It is one of the beautiful things about nursing - the possibilities are endless.

 

[DonDraper]

I just want to jump in here so no one gets the wrong impression of nursing.
you are correct in that an RN cannot order tests and treat. BUT an Advance Practice Nurse ( Nurse Practitioner ) can. I am an NP and I can work independently without an MD looking over my shoulder. I have the autonomy to diagnose, treat, order tests, etc in any setting.
I actually worked in Endocrinology before I left to have babies

so don't rule out nursing, you just have to go the NP route. We work independently

True but it's not like you get a nursing degree and walk out the door and become an NP. This takes a significant amount of time to get into. Honugirl was wondering if she could hold up physically in med school.. well it takes one hell of an effort to make it all the way to NP..

 

[honugirl]

There is also nurse anesthetist and certified nurse midwife if you are interested in either one of those fields. Our CNM's share a practice with MD's but see their own patients, order their own labs, tests, prescriptions etc.

Thanks for those options too. I don't think nurse midwife is for me. I don't do well with anything that has to do with birthing babies, but nurse anesthetist would be a direction I could possibly be interested in.

Honugirl, I also thought that when I read the post that npmommie quoted, but for a different reason than the one she posted from her perspective as an NP.

What I would tell you is to not underestimate the good you can do as an RN (even a plain ole' RN) in the endocrine community. One of the roles that nursing plays is that of patient advocate. That means that, as an RN, you help patients understand what things mean and what they need to do to take care of themselves. It's actually one of the things I've become expert at during the course of my career. It's rewarding to be able to sit down with patients and families and explain things in such a way that they finally "get it", sometimes for the first time - even in patients that have had a disease for a long time. You CAN make a difference, for sure.

Patients also like to be taken care of by people who've had medical issues to deal with themselves because they feel like their frustrations and pain, etc, is understood. I take care of patients with life threatening illnesses and when (and if) I share with them that I've had one, too, it's like a sigh of relief comes over them. I've kind of always felt that a prerequisite to taking care of patients should be having to be in that bed yourself first to experience things from a patient's perspective. (This was an interesting experiment I came across recently, speaking of that.) Additionally, nurses not only work in hospitals and doctors offices and such, they start their own businesses and things like that, usually as the result of seeing a need. It is one of the beautiful things about nursing - the possibilities are endless.

I totally hear what you're saying Pea and I can relate to the good some nurses too. I've had some amazing ones that have definitely helped me out along the way. My fear is that knowing what I know and going through what I've gone through, endos are a stubborn lot, they don't change their minds easily on things, so it's kind of like the old adage, "if you can't beat them, join them" thing that is truly going to help get changed.

I totally agree that both doctors and nurses should have to be in bed as a patient before they graduate school. They need to know what it's like to walk in our shoes.

But I will definitely keep NP in the back of my mind still as a viable career option. I'm going to get a BA in biochemistry so whichever direction I am able to go in, many of my pre-reqs will already be met.

True but it's not like you get a nursing degree and walk out the door and become an NP. This takes a significant amount of time to get into. Honugirl was wondering if she could hold up physically in med school.. well it takes one hell of an effort to make it all the way to NP..

I definitely understand nursing school is one heck of a load! That's for sure and I do know it's strenuous, but I've never seen nurses pull 24 shifts unless there's an emergency situation whereas residents routinely do. I don't know where my body will be 2-3 years from now. I may be able to handle the rigors of medical school just fine, or it may not. It's a crap shoot. As far as I know, medical school has never been attempted by someone with my disorder. So I guess one could ask, is it because they haven't tried or is it because their body can't hold up? I don't know. I truly won't know until I get there, but I know I need to have backup options just in case, so it's great to find out this info now.

 

[disfan07]

I definitely understand nursing school is one heck of a load! That's for sure and I do know it's strenuous, but I've never seen nurses pull 24 shifts unless there's an emergency situation whereas residents routinely do. I don't know where my body will be 2-3 years from now. I may be able to handle the rigors of medical school just fine, or it may not. It's a crap shoot. As far as I know, medical school has never been attempted by someone with my disorder. So I guess one could ask, is it because they haven't tried or is it because their body can't hold up? I don't know. I truly won't know until I get there, but I know I need to have backup options just in case, so it's great to find out this info now.

4 of my doctors work at the medical school associated with my hospital and they all want me to pursue medical school but I am kind of in the same situation. I had surgery last year for a brain tumor that while benign, I still have some residual issues from the surgery and there is a possibility that it could come back and this cyst is considerd a rare disorder so no one really knows what could happen if it comes back
I also have severe refractory asthma which puts me in the hospital about twice a year (about 10-15 days total)
I also have 4 other chronic conditions that impact me in one way or another (appointments, medication side effects, treatments, etc)
And it looks like I might have RA now as well (we are still waiting for the final results)
So I always wonder if pursuing an MD would be a smart idea.

My asthma is not going to get any better. We're out of treatment options so if it gets worse, we have no idea what could happen. If the cyst comes back, surgery might not be an option again and it could casue seizures, vision problems balance issues, etc. It's a constant state of "what if.." and medical school is so expensive and time consuming that pursuing it with so many what ifs hanging around is terrifying.

They all constantly tell me that I would be able to finish because the school and residency programs would work with me. When they were residents they were routinely working 100 hour weeks but now hospitals have caps on how long residents can work. At my hospital, the cap is 70 hours per week. which is still a lot but more managable.

I have a backup plan as well with a B.A in psychology and scial behavior, a B.A in Public Health Policy and I will pursue an MBA in healthcare management but it is a lot of money to put into something that might not work out.

I have to say though, I would love to go to medical school where my doctors work and learn from them because they have been so amazing.

Do you think your doctors would have any input about medical school? Like do you know what they think your body could handle? Could you ask them....as long as you trust their opinion about it. I trust my doctors and they are absolutely amazing people so I trust that if they think it would be possible and think that with the right support that I could handle it, I do take that into consideration. I trust their opinion about this just as much as I trust them with my medical care.

 

[DonDraper]

When they were residents they were routinely working 100 hour weeks but now hospitals have caps on how long residents can work. At my hospital, the cap is 70 hours per week. which is still a lot but more managable..

Maybe a Doctor can correct me if I'm wrong here but I believe that cap is only for primary care. If you go into a specialty like surgery, derm, something along those lines.. the hours that you work in residency can be closer to 100.

 

[Deb in IA]

Maybe a Doctor can correct me if I'm wrong here but I believe that cap is only for primary care. If you go into a specialty like surgery, derm, something along those lines.. the hours that you work in residency can be closer to 100.

The 80 hour limit, averaged over 4 weeks, applies to all fields.

There are rare cases for a 10% extension in the duty hours, to 88 hours, but only after a formal request by the institution and approval by the Residency Review Committee, some of which categorically do not permit this exception.

From the ACGME website:

Duty Hour Exceptions
“A Review Committee may grant exceptions for up to 10% of the 80-hour limit to individual programs based on a sound educational rationale.”
Question: Can duty hours for surgical chief residents be extended to 88 hours per week?
Duty Hour FAQs 3
Answer: Programs interested in extending the duty hours for their chief residents can use the “88-hour exception” to request an increase up to 10% in duty hours on a program-by-program basis, with endorsement of the sponsoring institution’s graduate medical education committee (GMEC) and the approval of the Review Committee. Requests for an exception must be based on a sound educational justification. Some Review Committees categorically do not permit programs to use the 10% exception.

 

[DonDraper]

The 80 hour limit, averaged over 4 weeks, applies to all fields.

That's right. So a resident can still potentially be working several days of 20 hour shifts and then maybe have a couple lesser days to bring down that average. It's not as if a resident can plan on working 6 to 6 each day and they're good.

 

[crz4mm2]

Thanks for those options too. I don't think nurse midwife is for me. I don't do well with anything that has to do with birthing babies, but nurse anesthetist would be a direction I could possibly be interested in.



I definitely understand nursing school is one heck of a load! That's for sure and I do know it's strenuous, but I've never seen nurses pull 24 shifts unless there's an emergency situation whereas residents routinely do. I don't know where my body will be 2-3 years from now. I may be able to handle the rigors of medical school just fine, or it may not. It's a crap shoot. As far as I know, medical school has never been attempted by someone with my disorder. So I guess one could ask, is it because they haven't tried or is it because their body can't hold up? I don't know. I truly won't know until I get there, but I know I need to have backup options just in case, so it's great to find out this info now.

Since you are not interested in birthing babies, this really doesn't apply, BUT CNMs are on call lots (and lots) and are frequently working for 24 hours straight....

 

[booger73]

That's right. So a resident can still potentially be working several days of 20 hour shifts and then maybe have a couple lesser days to bring down that average. It's not as if a resident can plan on working 6 to 6 each day and they're good.

Actually things have changed:

Interns (1st year) can't work more than 16 hrs straight
2nd year and above can work 24 hrs (+4 if they personally decide that leaving would jeopardize something.. interesting fact, huh!!!)

You have to have a 10 hour break in between shifts
You must have 24 hours off straight every 7 day

Total # is still 80

Read into it what you will about the impact on training, errors, hand-over, and preparedness of future doctors.

 

[DonDraper]

Actually things have changed:

Interns (1st year) can't work more than 16 hrs straight
2nd year and above can work 24 hrs (+4 if they personally decide that leaving would jeopardize something.. interesting fact, huh!!!)

You have to have a 10 hour break in between shifts
You must have 24 hours off straight every 7 day

Total # is still 80

Read into it what you will about the impact on training, errors, hand-over, and preparedness of future doctors.

Very interesting. I did not know that.

 

[booger73]

Very interesting. I did not know that.

Newest guidelines.. (as of July 2011)

ACGME "patrolling" itself/residents, etc.. before OSHA does.. (i.e. re: air traffic controllers)

In some ways guidelines are good.. in some ways they are not so good

[Cue the: When I was a resident music...]

Healthcare, i think, is about to change more than it has ever in the next few years.. as far as requirements, cost, changes, work-flow, limitations, and people being dissapointed/shocked or frustrated with it

 

[LovableGluttons]

I'll try to answer this simply. I am an RN and proud to be a nurse.

Things we have in common are that we both go into it wanting to help people from a healthcare perspective. But how we go about that is different, although we work cooperatively.

In other words, our professional perpectives focus on different things. Both things that help people from a health perspective.

These things are defined by our education and license to practice.



My definition of Medical Doctor will be shorter because I'm far more familiar with the definition of a nurse (and any medical doctors are welcome to chime in here - I did look around and this was the best I could do right now; big issue is to just show the inherent differences, not say one is better than the other, etc).



Now, obviously, the actualities of medical and nursing practice are FAR MORE complex and overlapping than what is listed here.

BUT, at the most basic level, the a doctor is educated and licensed to treat the person's illness and the nurse is educated and licensed to treat the person's response to their illness.

Most nurses go into nursing wanting to be a nurse because it's a worthwhile profession that helps people manage their health issues. They recognize their role and work within the perspectives and guidelines of nursing. If a nurse goes into nursing to be a "mini doctor", he or she will probably be pretty disappointed because the nursing perspective is different. Over the years I've trained a lot of nurses and it's been rare that I've had to say, "that is not your role". Nurses know their roles (although in certain areas, those lines may get a little blurred as the team works so closely together). And of course, advanced practice nurses such as Nurse Practitioners do take on some of the characteristics of medicine, although generally they never lose their perspective as a nurse (which is a great asset and why patients often enjoy them).

Nurses who want to be doctors go to medical school. My pediatrician started out as a nurse. Not surprised whatsoever as the first day I met her I didn't even know her (she was covering for my own pediatrician) yet she had an incredible bedside manner and gave me a hug when I became upset about something. I remember thinking if we ever needed to switch, I'd want her! And that's exactly what happened. We have a great working relationship because she understands how I think and I know she understands things from a "response to" perspective, even before she became a parent herself.

I could go on but I'll end here. I think you get the jist.

I work with great doctors and great nurses and am amazed every day at the work we do TOGETHER on behalf of our patients.

The last thing I want to say (and I'll put my flame suit on) is that, although there's controversy within the profession itself and this pathway was driven by the nursing shortage after WWII and the women's movement of the 50's and 60's, most professional nursing organizations feel that, with the complex needs of patients today, the entry to professional nursing practice should be at the bachelor's level (BSN), not the associate's. Some hospitals, such as my own, will only hire nurses who have a bachelor's degree or higher, and in fact many staff nurses have degrees at the master's level or above. The reason for this is that studies have shown that morbidity and mortality rates are lower for hospitals that employ mostly BSN nurses. Although people may disagree, this isn't really disputable. So yes, the bedside nurse you have in some hospitals may have almost as much education, training and experience as your doctor does. "2 years vs 8 yrs" can be very misleading.

Perfectly put! (hugs)

I became a nurse because I wanted to, not because I wanted to be a doctor. The two may work together, but they are so different.

I do not think anyone should become an RN with just a two year degree in mind. We are a profession, the minimum should be a for year for entry into practice.

 

[disfan07]

Maybe a Doctor can correct me if I'm wrong here but I believe that cap is only for primary care. If you go into a specialty like surgery, derm, something along those lines.. the hours that you work in residency can be closer to 100.

It can be different based on hospital.

There is a country wide max. that they can require but many hospitals set their own max as well.

My doctors personally don't think it will make too much of an impact on training. They don't think the 100 hour weeks were helpful. They think they would have learned more from shorter hour weeks. They were just too tired sometimes to absorb the information and the longer hours were pointless. They all teach the interns/residents on their rotation and they feel llike the same information is being taught and that the students are actually more receptive and retaining more because they are not so sleep deprived.

 

[justhat]

Actually things have changed:

Interns (1st year) can't work more than 16 hrs straight
2nd year and above can work 24 hrs (+4 if they personally decide that leaving would jeopardize something.. interesting fact, huh!!!)

You have to have a 10 hour break in between shifts
You must have 24 hours off straight every 7 day

Total # is still 80

Read into it what you will about the impact on training, errors, hand-over, and preparedness of future doctors.

Isn't it 1 day off in 7 OR 2 days off in 14? I know it seems like semantics, but I remember my husband had some periods of 12 days straight, then a weekend off. Luckily he was chief resident his last year so he got to make the residents schedules which meant we got some sort of say in planning our lives.

 

[DonDraper]

Isn't it 1 day off in 7 OR 2 days off in 14? I know it seems like semantics, but I remember my husband had some periods of 12 days straight, then a weekend off. Luckily he was chief resident his last year so he got to make the residents schedules which meant we got some sort of say in planning our lives.

How does one go about getting Chief Resident? Is it just the most promising doctor as voted on by superiors?

 

[cindy_belle]

How does one go about getting Chief Resident? Is it just the most promising doctor as voted on by superiors?

Depends on the residency program. It is up to the discretion of the Residency Director how they want to fill the Chief Residency position.

DH is a Residency Director and his Chief Residents are voted on by all the other residents and attendings. He only gets one vote just like the others and often he does not get the resident that he would have chosen for the position but that is life.

Other programs it is strictly the Residency Director who chooses them.

I guess it depends on what you call most "promising".

Chief Residents are usually picked for a variety of reasons, not necessarily for their intellectual ability or surgical/diagnostic skills. Usually they are picked for their organizational skills, teaching ability and ability to work well with others.

Chief Resident is an administrative position primarily. They make the on call schedules for the residents, field complaints about other residents, do the paperwork, find replacements for sick residents etc.

 

[booger73]

Isn't it 1 day off in 7 OR 2 days off in 14? I know it seems like semantics, but I remember my husband had some periods of 12 days straight, then a weekend off. Luckily he was chief resident his last year so he got to make the residents schedules which meant we got some sort of say in planning our lives.

I think the actual written rule is "1 day in 7 averaged over the four weeks.."
I'm sure that's subject to some interpretation like 2 in 14 like you said..

I would interpret it to mean many things such as:
You could do it many ways (i.e. take day 7, day 8 off out of 14 days) which would mean you're working day 1-6 and day 9-14.. but technically it's still 1 in 7 (i.e. day 7 of day 17, and day 8 of 8-14).. especially good when day 7 and 8 are on the weekend, obviously..

I'm not sure ACGME interviews everyone to say did you get your 4 days a month like this, or like that, or.. I wouldn't think a resident would be arguing over things such as working 12 days and getting day 13 and 14 off, especially if that's what they chose to do.. but then again, who knows. Just happy I'm not having to do that schedule Every little day here and there just impacts continuity, but somehow it all gets done every month

 

[Deb in IA]

Actually things have changed:

Interns (1st year) can't work more than 16 hrs straight
2nd year and above can work 24 hrs (+4 if they personally decide that leaving would jeopardize something.. interesting fact, huh!!!)

You have to have a 10 hour break in between shifts
You must have 24 hours off straight every 7 day

Total # is still 80

Read into it what you will about the impact on training, errors, hand-over, and preparedness of future doctors.

This is true.

For large teaching hospitals, this is causing havoc in resident scheduling. To cover all the floors and all the shifts, we are hiring more and more LIP's - PNP and PA's.